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Public Document 



No. 117 



Cfte CommonhieaUft of 0ia0$act)U0ett0 



ANNUAL REPORT 

OF THE 

COMMISSIONER OF MENTAL DISEASES' 

FOR THE 

Year ending November 30, 1923 




'UBI.ICATION OF THIS DOCUMENT APPROVED BT THE COMMIS-^ION ON ADMINISTRATION AND FiNANCB 



36^, ;2,/H3 
A 

TABLE OF CONTENTS. 



PAGE 

List of Commissioners 1 

Duties of the Department 2 

Activities of the Department 2-6 

Review of the Year : 

All Classes under Care 7 

The Insane 8-13 

The Feeble-minded 13, 14 

The Epileptic 14 

Report of the Pathologist 14-25 

Report of Director of Social Service 2o-28 

Report of the Committee on Training Schools 29 

Commitments for Observation and Temporary Care .... 29-31 

Stability of Service 31-33 

Capacity for Patients 34-36 

Institutions : 

Pubhc 37-68 

Private 68-71 

Family Care of the Insane 72-75 

The Department: 

Proceedings of 76 

Estimates of State Expenses for 1924: 

Maintenance Appropriation 76 

Special Appropriations 76, 77 

The Department 78 

Financial Statement of Department 78, 79 

Support Division 79-82 

Deportations 82, 83 

Financial Division 84^95 

General Matters: 

New Legislation 96-98 

Twenty-five Year Statement as to Special Appropriations . . 99-101 

Financial Statistics 102-136 

General Statistics 137-171 

Directory of Institutions 172-179 



COMMISSIONERS OF THE DEPARTMENT OF MENTAL DISEASES. 

November 30, 1923 



GEORGE M. KLINE, M.D., Commissioner Beverly. 

JOHN B. TIVNAN, Associate Commissioner ...... Salem. 

HENRY M. POLLOCK, M.D., Associate Commissioner .... Bostox. 

CHARLES G. DEWEY, M.D., Associate Commissioner .... Boston. 

ELMER A. STEVENS, Associate Commissioner ..... Somekville. 



LOWELL F. WENTWORTH, M.D., Assistant Commissioner. 
Publication of this Doccment approved by thf Co.vmissi ox Adm'n:si.r vr:oN and Finance. 



Cfte Commontoeaiti) of 9ga00aci)U0ett0 



EEPORT OF THE MASSACHUSETTS DEPAETMENT OF MENTAL 

DISEASES. 



DUTIES OF THE DEPARTMENT. 

The Department has general supervision of all public and private institutions 
for the insane, feeble-minded, epileptic, etc. It has the right of investigation and 
recommendation as to any matter relating to the classes under care. Each State 
Institution has, however, its own Board of Trustees appointed by the Governor 
and Council. 

The direct powers of the Department concern the inter-relation of institutions 
and matters which are common to them all, such as the distribution and transfer 
of patients, deportations to other states and countries, claims to support as state 
charges in institutions, etc. 

The Department inspects the institutions with reference to matters considered 
worthy of observation, and ascertains whether the laws relative to patients are 
properly observed. 

The expenditure of money under special appropriations is under the control of 
the Department, which is required to prepare plans for nev/ buildings and to 
select land to be taken for any new or existing institution. 

The Department also analyzes all requests for maintenance appropriations. 

The statutes relative to the powers and duties of the Department of Mental 
Diseases are to be found in Chapters 19 and 123, General Laws. 

Mr. Elmer A. Stevens was reappointed an Associate Commissioner in 1923. 

ACTIVITIES OF THE DEPARTMENT. 

The work of the Department has steadily increased in volume especially by the 
establishment of the new Divisions, such as Mental Hygiene and the Division for 
Feeble-Minded. The feeble-minded problem had grown to a point where a sepa- 
rate division was warranted. The work of the Division on Settlement and Support 
has continued heavy on account of the additional demand placed upon it by reason 
of the large number of veterans in our state institutions, by agreement with the 
Federal Government. 

Attention is directed to the special report of the Director of the Division of 
Mental Hygiene, which Division has been in existence for a year. This marks a 
very great forward step on the part of the State in the field of preventive work. 

FEEBLE-MINDED IN THE COMMUNITY. 

The Department has employed three additional trained psychiatric social serv- 
ice workers who have been assigned to the Division for Feeble-Minded in connec- 
tion with the community supervision work. Their efforts liave so far been directed 
to an investigation of problems connected with persons awaiting admission to the 
three schools for the feeble-minded, making adjustments whenever possible and 
in many cases rendering admission to the schools unnecessary. The State's pro- 
gram in the care of the feeble-minded is being developed along the line of com- 
munity care, the Department furnishing such supervision as may be necessary. 



P.D. 117. 



3 



. BELCHERTOWN STATE SCHOOL. 

The Belchertown State School which cares for the Feeble-Minded in the Western 
part of the State, has been in operation a year and has at the present time 480 
children under care. The program for Belchertown has been completed, and it is 
intended that the school will eventually care for two thousand children. Progress 
will be made as rapidly as appropriations are available. 



UNIFORM INSTITUTIONAL RECORDS. 

Doctors Walter E. Fernald, James V. May, William A. Bryan, Ransom A. 
Greene and Ralph M. Chambers were appointed a Committee on Uniform Insti- 
tutional Records in an endeavor to standardize, so far as possible, the records 
being used at the institutions under this Department. 

The needs of the various institutions have been determined and most of the 
work in standardizing forms has been completed, the printing being done at the 

Printing Plant 

established hy this Department at the Gardner State Colony. Work was begun 
in this plant the latter part of 1923. Modern equipment has been installed which, 
it is believed, will be sufficient to do most of the routine printing for the Depart- 
ment and the institutions. The Department has secured the services of Edward 
C. Cory, a man with years of experience in printing, who manages the plant, and 
the work is performed entirely by patients. 

The equipment consists of two automatic presses and two presses that are fed 
by hand. These presses are of different sizes, making it possible to do all kinds of 
work. The plant is located temporarily in a part of the new laundry building at 
Gardner. This has been partitioned off with glass and wood to prevent moisture 
from the laundry damaging the paper and presses, but the partitions have been 
placed in such a way as not to interfere with the lighting. It is beheved that be- 
fore very long this plant will be sufficient to do all of the work of the Department 
and the institutions. 

SCHOOL CLINICS. 

Chapter 277 of the Acts of 1919 authorized the School Committee of each city 
and town to ascertain, within one year after the passage of the Act, and annually 
thereafter (under regulations prescribed by the Board of Education and the Com- 
missioner of the Department of Mental Diseases), the number of children three 
years or more retarded in mental development who are in attendance upon the 
public schools of its city or town or who are of school age and reside therein. The 
Act also provided that the School Committee of each city or town in which there 
are ten or more children three years or more so retarded shall establish special 
schools to give such children instruction adapted to their mental attainments, 
under regulations prescribed by the Board of Education. 

In passing this act for the enumeration and instruction of children retarded in 
mental development, the State recognized an important educational need. The 
fundamental purposes of the law are: (1) To discover those children of school 
age who are so retarded in mental development that they can derive but little 
benefit from the regular academic work of the schools; and (2) to provide for them 
a practical type of training and supervision which will enable them, so far as pos- 
sible, to become safe and self-supporting members of society. 

In accordance with the provisions of the act the Department of Education and 
the Commissioner of the Department of Mental Diseases presented the following 
regulations and instructions for determining the number of children who should 
receive special training : — 



4 



P.D. 117. 



"Only those pupils should be considered qualified for the special classes who 
have been examined by approved methods and properly qualified persons, and 
judged to be three years or more retarded in mental development. 

The examination of suspected cases should be thoroughly done, and should 
include the following fields of inquiry: — 

(a) Physical examination. 

(6) Family history. 

(c) Personal and developmental history. 

(d) School progress. 

(e) Examination in school work. 

(J) Practical knowledge and general information. 

(g) Social history and reactions. 

(h) Economic efficiency. 

(i) Moral reactions. 

0") Mental examinations. 

In a definitely feeble-minded child evidence of the mental defect will be found 
in most or all of the ten fields. The evidence in no one field may be conclusive 
by itself, but the sum of the findings will be convincing for or against a diagnosis 
of mental deficiency. 

All information secured in the examination should be regarded as confidential. 

A card has been provided for summarizing the results of the examination of 
each pupil qualified for admission to a special class. This card is made out in 
duplicate and one copy forwarded to the Commissioner of the Department of 
Mental Diseases, State House, Boston. 

As an important means of conducting these comprehensive examinations out- 
lined herein there are mental clinics now in operation in various parts of the State 
to which children can be taken and there examined as to their mental develop- 
ment. It is intended that these clinics shall be freely used for the purpose of ex- 
amining backward pupils, and in this work fchey will be found especially valuable 
to the smaller towns and rural communities. 

It is suggested that one or all of the following methods be employed by school 
officials in selecting the pupils to be examined for admission to the special 
classes : — 

1. Select by reference to individual school records those pupils who have re- 
peated two or more grades, 

2. Select those who, failing to earn promotion two or more years, have been 
allowed by the school officials to advance with their grades as being for their best 
interests. 

3. Select those who by an age-grade table are shown to be retarded in their 
school work two or more years. 

In several investigations involving large numbers of school children it has been 
found by competent authorities that hardly more than 1 per cent were mentally 
deficient and proper subjects for special instruction. 

Care should be taken to exclude from the special classes those low-grade mental 
defectives who would be unable to profit by the instruction given, and who should 
properly be provided for in the home or in an institution. 

Under normal conditions special classes established under this act should not 
include more than twenty-five pupils. 

Instructions relative to the character of the work and methods to be employed 
in these special classes will be issued by the State Department of Education, as 
prescribed by law. 

In accordance with the Act of 1919, the work of the traveling clinics was begun 
in 1920, the cities and towns of the state being divided into districts for the vari- 
ous hospitals and schools. Each state hospital and school has a clinic union for 
the cities and towns assigned to it. 

The clinic group consists of a psychiatrist, psychologist, social worker and clerk. 



P.D. 117. 



5 



The clinic group visits the different cities and towns in turn. About fifty pupils 
can be examined in a week. 

There are on file, at the present time, 9,679 cards for persons who have been 
examined by the school clinics. 

The school authorities in the various localities have shown the greatest interest 
in the work and have co-operated to the fullest extent. 

REGULATIONS. 

The following regulations in connection with newly admitted patients to State 
Hospitals were approved : 

Each patient admitted to a State Hospital shall be received by a physician and all 
patients admitted except those received in large transfers from another hospital, but 
including such as may be especially designated by the transfer agents, shall immediately 
be given a complete physical examination. A full and careful record of the examination 
shall be made, and the existence of any serious injury or critical illness shall be immedi- 
ately reported to the Superintendent. 

Patients returning to a hospital from escape or visit are also to be received by a 
physician and their condition carefully noted. 

Special precautions must be taken with paretic cases, and other disturbed, confused 
patients who are liable to be injured because of their annoyance to and interference 
with others, or who might exhaust or injure themselves if not fully protected. Such 
patients must also be given close supervision at night and must not be allowed to 
wander about. 

Voluntary Patients. 
The following regulations relating to voluntary patients were adopted: 

I. No minor shall be received as a voluntary patient. 

II. No person shall be admitted as a voluntary patient if he is commitable as an 
insane person nor unless he is fully competent to understand the conditions of such 
admission and his rights in the matter of discharge, and would be able to convince a 
court of such competency. 

A person so admitted shall be given a copy of his application, and should he give 
oral notice to a medical officer of the institution that he desires to leave, a written 
notice to that effect shall be prepared and offered him for signature. 

III. Should the mental condition of a voluntary patient so change as to render him 
incompetent to understand his status or to necessitate forcible restraint or detention, 
steps must be taken at once for his commitment or discharge, and if the persons re- 
sponsible for or representing him object to his commitment, the matter shall be reported 
by the superintendent to the Department, which will investigate the case and may 
take action as provided by Section 23, Chapter 123 General Laws. 

IV. All voluntary patients now in the institutions are to be held subject to the 
conditions set forth in III of these regulations. 

It is contrary to the intent of the voluntary statute that persons admitted under 
its provisions should remain permanent residents of institutions in that standing. 
It is therefore advised that the several superintendents carefully review their 
voluntary cases and either discharge or have committed those of long standing. 
And in general, it is deemed inadvisable to continue a patient in the voluntary 
status beyond the period of twelve months, nor should a voluntary patient be 
carried as a visitor for longer than 48 hours. 

Voluntary cases now in the institutions falling outside these regulations or such 
cases seeking admission must be referred to this Department. 

These regulations are not to be held as applying to the Monson State Hospital 
nor to the Schools for the Feeble-Minded. 



6 



P.D. 117. 



MISCELLANEOUS. 

With the establishment of the Commission on Administration and Finance, 
one bureau of which deals with a central purchasing department, the purchasing 
as formerly supervised by this Department, which was collective purchasing by 
the institutions on specifications in which the institutions had a voice, has been 
taken over by the new purchasing bureau. The Comptroller's Bureau has installed 
a new system of accounting. These changes have necessarily occupied consider- 
able time on the part of the Department and the institutions. 

The Department requested Dr. James V. May, Superintendent of the Boston 
State Hospital, to serve as Chairman of a Committee of Superintendents to deal 
with the Standardization of Regulations in Connection with Fire Prevention at 
the institutions under the Department, the other members of the Conmiittee 
being Dr. Harlan L. Paine and Dr. E. H. Cohoon. 

It was voted that the institutions under the supervision of the Department of 
Mental Diseases be required to file with the Department their monthly analyses 
of maintenance expenses at the time the monthly schedules and bills are filed. 

It was voted to do away with the Dry Pack; and its use in all institutions under 
the supervision of the Department of Mental Diseases was discountenanced and 
prohibited. 

Mr. Fred A. Hewey, Transportation Officer of the Department since immedi- 
ately after the organization of the State Board of Insanity in 1898, retired from 
the service of the Commonwealth on February 27, 1923, he having reached the 
age of seventy years. The Department expresses its appreciation of his long and 
faithful service. 

RECOMMENDATIONS FOR LEGISLATION. 

1 . Relative to the Investigation by the Department of Mental Diseases of the Mental 
Condition of Certain Persons held for Trial. — This amendment is desired so as to 
include all indictments for homicide, and to provide that the necessary information 
is to be furnished by the clerks of courts. 

2. Relative to determining the Jurisdiction of the Department of Mental Diseases 
and Correction respectively over Certain Feeble-minded Persons. — This legislation 
is desired to give the Department the necessary authority to make selection of 
cases to come under its custody or supervision, and to correct certain defects 
in the Statute relating to discharge of certain defective delinquents. 

3. Relative to Commitment of Persons for Observation as to their Sanity. — This 
legislation is desired to correct certain defects in the Statute. 

4. Changing the Time within which Actions relative to the Support of Insane Pub- 
lic Charges may be brought. — To enable the Department to bring action for the 
support of public charges in Institutions for twelve years instead of six. 

5. Requiring the furnishing of Additional Information to the Department of Mental 
Diseases in Certain Probate Matters. — To provide that the department shall be 
notified of bequests left in trust for the benefit of inmates of institutions. 



P.D. 117. 7 
REVIEW OF THE YEAR. 

ALL CLASSES UNDER CARE.i 



The number and location of the classes actually in the institutions and in family- 
care Oct. 1, 1923, were: — 

























ded. 


c 


(san 








s 


Location. 




c 






>, 










c 


'a 
1 

0) 


•43 
a 





2 
a 


C3 

'C 




6 




c8 

00 

C 


3 

a> 
a> 






B 

V 


Si 
<u 
a 














> 






H 






2,139 




- 




9 


- 


2,149 


- 




1,409 




- 




7 


- 


1,416 


- 


Northampton State Hospital .... 


1,085 




- 




4 


- 


1,089 


- 


Danvers State Hospital 


1,663 




- 




3 


- 


1,666 


- 




1 325 




- 


7 


5 


- 


1,337 


- 




2,109 




- 




5 


- 


2,114 


- 


Boston Psychopathic Hospital .... 


34 


_ 


- 


3 


29 


- 


66 


- 
















1,465 


- 


Medfield State Hospital 


1 703 




- 




2 


- 


1,705 


- 


Gardner State Colonv 


937 


- 


- 


- 


2 


- 


939 


- 


Monson State Hospital ...... 


328 




761 






- 


1,089 


- 


Foxborough State Hospital 


567 








2 




569 




Mental Wards, State Infirmary .... 


712 




- 






- 


712 


- 




87R 
o/D 












876 




Family Care under Department .... 


27 




_ 




_ 


_ 


27 


- 


Massachusetts School for the Feeble-minded at 




















- 


1,576 


- 




- 


- 


1,576 


- 


Wrentham State School 


- 


1,235 


- 


- 


- 


- 


1,235 


- 


Belchertown State School ..... 


- 


428 


- 




- 


- 


428 


- 


Hospital Cottages for Children 2 . . . . 


- 


76 


- 




- 


- 


76 


20 


McLean Hospital ....... 


211 




- 


1 


2 


- 


214 


- 


Elm Hill Private School and Home for the Feeble- 




















- 


33 


- 




- 


- 


33 




Twenty other Private Institutions 


133 


35 




19 


2 


28 


217 








147 










147 






16,723 


3,530 


761 


31 


72 


28 


21,145 


63 


Viz.: 




















16,379 


3,462 


761 


11 


68 




20,681 


20 


Institutions and family care under trustees . 


16,352 


3,315 


761 


11 


68 




20,507 


20 


Family care under Department 


27 












27 




Almshouses . 




147 










147 






344 


68 




20 


4 


28 


464 


43 




211 






1 


2 




214 




Twenty-one private institutions 


133 


68 




19 


2 


28 


250 


43 



1 See Tables Nos. 11 and 12 for whole number under care, inclusive of patients absent on visit or escape. 
- Placed again under care of Department, April, 1918. 
3 Taken from reports of overseers of poor, March, 1923. 
* Includes temporary-care cases. 



The Whole Number of the Classes 

under care October 1, 1923, was 21,145, being 1 such person to every 189 of the 
estimated population of the State. Of this number 16,723 or 79.08 per cent, were 
insane; 3,530 or 16.69 per cent, feeble-minded; 761 or 3.60 per cent, epileptic 
(sane); 28, or .13 per cent, inebriate; 72, or .34 per cent, temporary-care cases, 
and 31, or .16 per cent, voluntary sane. There was an increase for the year of 551. 

The whole number of such persons under pubhc care was 20,681 ; under private 
care, 464. 

The increase of such persons under public care for the year was 546; their 
average annual increase for the last five years, 379. 



s 



P.D. 117. 



THE INSANE 

in institutions and family care October 1, 1923, numbered 16,723, being 1 insane 
person to every 239 of the estimated population of the State. In addition, there 
were 2,214 persons who were temporarily absent from institutions, and a consid- 
erable number of others in the community who had been previously discharged 
or had never appeared in institutions for the insane. The figures for insane are 
exclusive of temporary-care cases. 

The insane appear under public care in public institutions and in family care, 
at public expense, and under private care in private institutions. Their number 
and increase in these locations for the year, the last five years, the last ten years 
and the last twenty-five years are shown as follows: 





Number, Octo- 
ber 1, 1923. 


Increase over Pre- 
vious Years. 


icrease, 
rs. 


icrease, 
■s. 


Average Increase, 
Twenty-five 
Years. 




Males. 


Females. 


Totals. 


1923. 


1922. 


1921. 


1920. 


1919. 


Average In 
Five Yea 


Average In 
Ten Yeai 


Public Institutions i . 

Family care under Department . 


7,926 


8,426 
27 


16,352 
27 


225 

22 


356 

22 


642 

32 


171 

42 


742 

62 


264. 
3.42 


326.9 
30.92 


390. 
3.42 


Total, public 
Private institutions 


7,926 
101 


8,453 
243 


16,379 
344 


223 

122 


354 

22 


639 
3 


167 
12 


802 
52 


260.6 

.82 


296.0 
.32 


386.6 
4.24 


Total, public and private 


8,027 


8,696 


16,723 


211 


352 


642 


179 


852 


259.8 


295.7 


390.84 



1 Includes 141 patients in family care by Trustees. 

2 Decrease. 



The Inckease of the Insane 

under care for the year was 211, compared with an increase of 352 the previous 
year; 259, the average annual increase for the last five years; 295, the last ten 
years, and 390, the last twenty-five years. 

The number of non-resident insane was 80, compared with 72 the previous year. 

It is the pohcy of the State not to receive into its institutions non-residents, 
even as private patients, unless their friends are resident in Massachusetts and 
have just claims for such service. 

The Increase of the Insane under Public Care 

was 223, compared with an increase of 354 the previous year; 260, the average 
annual increase for the last five years; 296 the last ten years; and 386 the last 
twenty-five years. 

The Insane under Private Care 

decreased 12, compared with an average annual decrease for the last five years of 
.8; the last ten years, .3; and an increase of 4 for the last twenty-five years. 

Family Care under the Department. 

There was a decrease of 2 in the number under care. The number in family 
care under institutions on October 1, 1923, was 141, a decrease of 29. 

The number under family care has not increased because of the advance in the 
cost of living and the small rate of board paid. The Legislature has, however, 
authorized an increase in the rate of board of such patients from $3.75 to $4.50 
and it is hoped that the number of patients placed in family care will again show 
an increase. 



P.D. 117. 



9 



FIRST CASES OF INSANITY 

appeared in public institutions and McLean Hospital to the number of 2,836. 
Of all the admissions of the insane to these institutions (inclusive of insane volun- 
tary), 78.21 per cent appeared for the first time in any institution for the insane, 
compared with 79.05 per cent the previous year. One insane person came under 
care for the first time from every 1,411 of the population of the State. 

The Nativity 

of such first cases of insanity does not differ materially from the percentages of 
the previous year. Exclusive of 8 whose birthplaces were unknown, 1,582, or 55.94 
per cent, were born in the United States, compared with 57.49 per cent the pre- 
vious year, and 1,246, or 44.06 per cent, in foreign countries, compared with 42.51 
per cent the previous year. 

The Parentage 

also corresponds substantially with the percentages of previous years. Exclusive 
of 142 whose birthplaces were unknown, 648, or 30.86 per cent, of the parents of 
male patients were born in the United States compared with 28.69 per cent the 
previous year, and 1,452, or 69.14 per cent, in foreign countries, compared with 
71.31 per cent the previous year. 

Exclusive of 163 whose birthplaces were unknown, 651, or 33.99 per cent, of 
the parents of female patients were born in the United States, compared with 
32.79 per cent the previous year and 1,264, or 66.01 per cent, in foreign countries, 
compared with 67.21 per cent the previous year. 

Citizenship. 

Of the 2,836 first admissions as insane, 1,581, or 55.75 per cent, were citizens by 
birth, compared with 57.42 per cent the previous year, and 388, or 13.68 per cent, 
by naturalization, compared with 15.29 per cent the previous year. There were 
652 aliens, or 22.99 per cent, compared with 22.82 per cent the previous year, and 
215, or 7.58 per cent, where the citizenship was unascertained, compared with 
4.48 per cent the previous year. 



Psychoses of First Admissions 

were as follows: 





1923. 




Psychoses. 






Average 


Cases. 


Per Cent. 


Previous Year 




10 


.35 


.36 




272 


9.59 


9.24 




332 


11.71 


9.33 




239 


8.43 


7.18 




21 


.74 


.57 


With Huntington's chorea ....... 


3 


.11 


.24 




3 


.11 


.18 




46 


1.62 


1.25 


Alcoholic 


222 


7.83 


6.41 


Due to drugs or other exogenous toxins .... 


15 


.54 


.36 


With pellagra 


2 


.07 


.12 


With other somatic diseases ....... 


105 


3.70 


2.56 


Manic depressive 


314 


11.07 


9.89 


Involution melancholia 


74 


2.61 


2.80 




618 


21.79 


23.18 


Paranoia and paranoiac conditions ..... 


72 


2.54 


2.53 


Epileptic psychoses 


61 


2.15 


3.40 




36 


1.26 


3.25 


With constitutional psychopathic inferiority 


36 


1.26 


.59 


With mental deficiency 


73 


2.57 


3.87 


Undiagna«ed . . 


195 


6.88 


6 82 




87 


3.07 


5.87 



10 



P.D. 117. 



The following 6 forms of psychoses — namely, senile, 9.59 per cent; with cere- 
bral arteriosclerosis, 11.71 per cent; general paralysis, 8.43 per cent; alcoholic, 
7.83 per cent; manic-depressive, 11.07 per cent; dementia prsecox, 21.79 per cent 
— furnished 70.42 per cent of first admissions, compared with 65.23 per cent the 
previous year. 

Race. 

The races named below furnished the greatest number of first admissions. 





1923. 




Race. 






Average 
Previous Year. 




Cases. 


Per Cent. 






520 


18.33 


19.60 




677 


23.87 


23.69 




122 


4.30 


4.70 




201 


7.08 


6.67 




55 


1.93 


2.29 




134 


4.72 


4.97 




61 


2.15 


1.96 




61 


2.15 


2.38 




500 


17.63 


12.69 




90 


3.17 


3.60 


African, black 


77 


2.71 


2.02 



Ages. 





1923. 




Yeahs. 






Average 


Cases. 


Per Cent. 


Previous Year. 


Under 20 


142 


5.00 


7.54 


From 20 to 25 


230 


8.11 


8.64 




250 


8.81 


10.67 




276 


9.73 


10.16 


From 35 to 40 


308 


10.86 


10.46 




256 


9.03 


8.31 


From 45 to 50 


245 


8.64 


7.72 


From 50 to 55 


212 


7.48 


7.72 


From 55 to 60 


175 


6.17 


5.90 


From 60 to 65 


170 


6.00 


5.60 




160 


5.64 


5.12 


Over 70 


410 


14.46 


12.02 


Unknown 


2 


.07 


.14 



Degree of Education. 





1923. 










Average 








Previous Year. 




Cases. 


Per Cent. 




Illiterate 


249 


8.78 


9.42 


Could read and write 


442 


15.59 


16.00 


Attended common school 


1,552 


54.72 


52.56 


High school education 


335 


11.81 


13.65 


Attended college 


89 


3.14 


2.20 


Education unascertained 


169 


5.96 


6.17 



Environment. 

The urban districts furnished 2,557, or 90.16 per cent, of the first admissions, 
compared with 90.58 per cent the previous year; rural localities, 265, or 9.35 per 
cent, compared with 8.82 per cent the previous year; and there were 14 or .49 
per cent, whose place of residence was unknown, compared with .60 per cent the 
previous year. 



P.D. 117. 11 

The Economic Conditions 

of these admissions are shown as follows : 





1923. 


Average 
Previous Year. 


Cases. 


Per Cent. 


Comfortable 


495 
1,713 
512 
116 


17.46 
60.40 
18.05 
4.09 


15.38 
60.37 
20.41 
3.84 



The admissions under Alcoholic Psychoses number 222, or 7.83 per cent of first 
admissions as insane. This is an increase of 1.42 per cent over the previous year. 
Since 1920, there has been an increase of 4.21 per cent. The Hospital reporting 
the largest number of Alcoholic Psychoses was the Danvers State Hospital. 

The admissions classed as Intemperate under the table ''Use of Alcohol" were 
15.83 per cent of first admissions compared with 14.33 per cent the previous year, 
an increase of 1.50 per cent. In 1920, 10.57 per cent were reported. It thus ap- 
pears that there has been an increase of 5.26 per cent in Alcoholic Intemperance 
since 1920. 

Use of Alcohol. 





1923. 


Average 




Cases. 


Per Cent. 


Previous Year. 


Temperate 


814 
448 
220 


47.74 
28.70 
15.80 
7.76 


55.48 
23.57 
14.33 
6.62 





Marital Condition. 

It appears that 1,138, or 40.13 per cent, were single at the time of admission 
compared with 43.08 per cent the previous year; 1,143, or 40.30 per cent married, 
compared with 40.11 per cent the previous year; 462, or 16.29 per cent widowed; 
compared with 14.45 per cent the previous year; 19, or .67 per cent separated, 
compared with .57 per cent the previous year; 54 or 1.90 per cent divorced, com- 
pared with 1.34 per cent the previous year; and there were 20, or .71 per cent, 
whose marital condition was unknown, compared with .45 per cent the previous 
year. 

ALL DISCHARGES. 

The Results of Mental Diseases 

at public institutions and McLean Hospital are shown in the conditions of patients 
on discharge. 





1923. 










Average 








Previous Year. 




Cases. 


Per Cent. 




Recovered 


292 


15.36 


13.29 




1,110 


58.36 


48.97 


Not improved 


376 


19.76 


28.51 


Not insane at time of discharge ...... 


124 


6.52 


9.23 



12 



P.D. 117. 



The Recovery Rate 

for the whole State numbered 339, or 8.81 per cent of all admissions of the insane. 

The percentages of recoveries under public care and at McLean Hospital (in- 
clusive of insane voluntary) were : 





1923 


Average 




(Per Cent). 


Previous Year. 




8.05 


6.85 




1.80 


1.82 



DEATHS. 

The death rate of the insane for the whole State during the year was 9 . 05 per 
cent of the daily average number in the institutions, compared with 9.10 per cent 
the previous year. The percentages of deaths in public institutions and McLean 
Hospital were : — 





1923 

(Per Cent). 


Average 
Previous Year. 


Of daily average number in institutions 

Of discharges (inclusive of deaths) 


9.00 
43.42 


9.00 
39.68 



Cerebral arteriosclerosis was present in 18.49 per cent; general paralysis in 
16.57 per cent; manic-depressive in 6.50 per cent; dementia prsecox in 18.97 per 
cent; epilepsy in 4.24 per cent; alcoholic psychosis in 4.17 per cent; senile psy- 
chosis in 16.77 per cent. 

These seven forms were present in 85.71 per cent of the deaths, compared with 
85.37 per cent the previous year. 



The Age of Patients 
at the time of death was as follows : 



Years. 


1923 

(Per Cent). 


Average 
Previous Year. 


Under 20 




.89 


.55 


20 to 25 . 




1.51 


1.60 


25 to 30 . 




2.81 


3.40 


30 to 35 . 




4.38 


4.24 


35 to 40 . 




5.27 


5.56 


40 to 45 . 




8.08 


7.01 


45 to 50 . 




8.76 


7.57 


50 to 55 . 




7.74 


7.85 


55 to 60 . 




10.14 


.8.68 


60 to 65 . 




9.73 


9.72 


65 to 70 . 




10.35 


11.53 


70 and over . 




30.34 


32.29 



P.D. 117. 

The Duration of Hospital Life 
of patients who died was as follows : 



13 



Duration. 


1923 

(Per Cent). 


Average 
Previous Year. 


Less than 1 month 




15.55 


16.39 






13.01 


13.26 






10.27 


9.38 






6.10 


6.67 






17.19 


16.04 






9.59 


10.14 






12.67 


11.67 






4.93 


5.83 






4.18 


3.19 






6.51 


7.29 








.14 



Further statistical details on which the foregoing statements and conclusions 
are based will be found in the Appendix, beginning with Table No. 11. 

THE FEEBLE-MINDED. 
The Whole Number of the Feeble-Minded 

actually in the institutions and in almshouses October 1, 1923 was 3,530, being 1 
feeble-minded person to every 1,133 of the estimated population of the State. 

The feeble-minded appear under public care in public institutions and alms- 
houses, and under private care in private institutions. Their number and increase 
in these locations for the year and the last five years are shown as follows : 





Number Oct. 


1, 1923. 


Increase over Pre- 
vious Years. 


Lcrease, 
rs. 




















« & 
HI a> 
























05 


i 














2 > 






a 


s 


a 









o> 











H 


a* 


0> 


o> 




o> 


< 


School for the Feeble-minded at Waltham . 


929 


647 


1,576 


291 


91 


16 


65 


181 


5.0 


Wrentham School ...... 


440 


795 


1,235 


91 


831 


105 


16 


61 


4.6 


Belchertown School ..... 


223 


205 


428 


428 










85.6 


Hospital Cottages for Children 2 . 


44 


32 


76 


2 


61 


51 


10 


1 


.4 




77 


70 


147 


561 


1151 


91 


3 


35 


8.41 




1,713 


1,749 


3,462 


336 


2131 


207 


94 


12 


87.2 


Elm Hill 


24 


9 


33 




31 


21 


31 


11 


1.81 


Smaller private institutions .... 


10 


25 


35 


10 


4 


141 


81 


51 


2.61 


Total, public and private 


1,747 


1,783 


3,530 


346 


2121 


191 


83 


6 


82.81 



1 Decrease. 

2 Placed again under care of Department, April, 191^. 



The Increase of the Feeble-minded 

under care for the year was 346, compared with a decrease of 212 the previous 
year, and 82, the average increase for the last five years. 

_ The number of non-resident feeble-minded was 27, compared with 26 the pre- 
vious year. Of these 25 were patients in private institutions, and 2 were private 
patients in State institutions. 



14 



P.D. 117. 



It is the polic}^ of the State to receive feeble-minded persons from other States 
only when there is no school for the feeble-minded in such States, and then only in 
urgent cases. The non-resident patients are paid for at a rate which fully compen- 
sates the State for the cost of their maintenance. 

THE EPILEPTIC. 

The Whole Number of the Epileptic 

under care October 1, 1923 was 1,551, being 1 epileptic to every 2,580 of the esti- 
mated population of the State. 

The epileptic appear under public care in the Monson State Hospital, the State 
hospitals and other public institutions, and under private care in private institu- 
tions. Details will be found under the Monson State Hospital. 

Their number and increase in these locations for the year and for the last five 
years are shown as follows: 





Number Oct. 1, 1923. 


Increase over Pre- 
vious Years. 


ncrease 
rs. 




















i-H a 

0) 
























ales. 


imal( 


CD 

Is 




«^ 
«^ 








Is 






r 




o> 


o> 


o> 


0) 








528 


561 


1,089 


241 


77 


76 


38 


321 


27 


Public institutions for insane 


222 


192 


414 


301 


41 


27 


81 


591 


5.81 


Schools for the Feeble-minded 


2 


3 


5 


31 






51 




1.61 




16 


4 


30 


71 


131 


101 


8 


51 


5.41 




768 


760 


1,538 


641 


105 


93 


33 


961 


14.2 


Private institutions 


7 


6 


13 


2 


21 


41 


10 


31 


.6 


Total, public and private 


775 


766 


1,551 


621 


103 


89 


43 


991 


14.8 



1 Decrease. 



The Deceease of the Epileptic 

under care for the year was 62, compared with an increase of 103 the previous 
year, and 14 the average increase for the last five years. 

REPORT OF THE PATHOLOGIST. 

To the Commissioner of the Department of Mental Diseases: 

This is the fifteenth report of the Pathologist and the fourteenth to cover a full 
year's work. 

I. General 

The status of the laboratory work in the State Hospitals in Massachusetts for 1922-23 
might be said to have progressed in hospitals where Pathologists are employed. It 
takes the energj^ and personal interest of a resident to keep up the pressure in any 
special line and certainly a lack is clearly seen in the absence of a pathologist in the 
scattering of equipment and the difficulty of its assemblage in an emergency: moreover, 
the staff officers feel neither acquainted with its whereabouts, nor responsible for its 
condition. Whether we believe in elaborate organization or not, we are somehow 
pleased at the evidences of it when its presence conduces to speedier attack on a problem 
and unconsciously we are troubled when we find nothing in readiness where no nucleus 
of laboratory work is established. The over functionalized staffs become more de- 
pendent on external signs for development of changed physical states in their patients 
and somewhat handicapped in medical judgments, if there is no one to appeal to for 
even simple chnico-pathological tests. 



P.D. 117. 



15 



There have been new plans and changes in the hospitals where the pathologists are. 
Dr. Charles A. Whitcomb has left for eight months' work in general medicine in Phila- 
delphia in order to be ready for the directorate of the medical work in the Worcester 
State Hospital. It is expected that with two assistants he will take entire responsibility 
for the physical state of the patients, examinations, X-ray pictures, laboratory reports, 
special examinations and medical treatment of all types of physical disease. Worcester 
then will stress the medical attention on the psychiatric cases. 

The Taunton laboratory through the efforts of Dr. F. D. Parker during his residence 
from February to June inclusive, restored the laboratory to a working shop by a thorough 
overhaul of its furniture, walls and fittings and put all in order except the icing for the 
bodies, which can of course, be together with the drains, entirely renewed. Dr. W. C. 
Baines arriving in October, succeeded to these and many other problems, which he left 
shortly to others. 

Dr. WiUiam Malamud, after seven months in the laboratory at Foxborough, during 
which time he added m.uch to the interest of staff meetings by injecting his points of view 
of patients from a wealth of philosophical thinking which he had previously done, had an 
opportunity to take a year at Mt. Sinai in New York as neurological resident. This 
he tliinks will more intelligently fit him for a combined attack on psychiatry from a 
neurological point of view as his previous training had developed an appreciation of 
the psychological angle, and he believes Massachusetts is his home. 

Dr. William Cluney, previously of Chicago and more recently in a general hospital 
laboratory in South Dakota, came to Medheld in March, keen on clinical pathology. 
It would take a special neuropathological training to at first appreciate the wealth of 
material at hand in Medfield. When patients have been in a hospital from 4-^40 years, 
the problem of gliosis must be ready for elucidation. 

Dr. Lydia B. Pierce at Westborough continues her interest in blood chemistry and 
clinical pathology with a query in her mind about diet in relation to mental diseases. 
As it must needs happen, she has been most handicapped by being without a technician 
for more than 6 months, which has cut down activities to a minimum since it has left 
the daily work for her to pursue alone, added to the responsibility of concrete jobs 
for summer internes. 

At Danvers a corps of eager undergraduate students has assisted in the work at 
that station during the summer, and with the plan of each psychiatrist rotating in the 
laboratory for a m.onth at a time to get a laboratory point of view, Dr. Kelly has had 
much teaching. His paper entitled "Acidophile Degeneration in Dementia Praecox" 
read at the Detroit meeting caused much favorable comment and should encourage 
him to major on the problem. 

The habit of monthly meetings of the pathologists suggested by Dr. O. F. Kelly, at 
the Department's Laboratory, 74 Fenwood Road, has been continued during the year 
and experience meetings they have been, where cases and specimens and problems 
have been discussed. Dr. Malamud presented the group with translated chapters of 
W. Spielmeyer's " Histopathology of the Nervous System." 



II. Routine of the Pathological Service: Autopsies. 

Since the establishment of the Pathological Service July 1, 1914, to Nov. 30, 1923, 
there have been 1,788 autopsies. These have been typed and bound up to Nov. 30, 
1922, leaving only 130 in the files. 

Dming the year ending Nov. 30, 1923 there have been 125 autopsies; last year 
there were 121. 

The following table shows the number of autopsies performed in the different insti- 
tutions by the pathological service of the Department (and exclusive of autopsies 
performed by the staffs of the institutions). 



Boston Hospital 
Boston Psychopathic Hospital 
Foxborough Hospital 
Westborough Hospital 
Medfield Hospital 
Massachusetts School for Feeble 

minded .... 
Taunton Hospital 
Danvers Hospital 



63 
16 
9 
9 
7 

7 
4 
3 



Belchertown School 
Gardner Colony 
Monson Hospital 
Grafton Hospital 
Wrentham School 
Miscellaneous . 

Total 



1 
1 
1 
1 
1 
2 

125 



16 P.D. 117. 

Table showing Proportion of Autopsies to Deaths in Institutions. 



Total 'T'^+„i 
"irX"' Numbe of 
fo° y'^r. Autopsies. 



Per Cent. 



Medfield Hospital ..... 
Boston Psychopathic Hospital . 

Foxborough Hospital 

Westborough Hospital .... 

Taunton Hospital 

Danvers Hospital 

Boston Hospital 

Worcester Hospital 

Massachusetts School for the Feeble-minded 

Gardner Colony 

Belchertown School ..... 

Grafton Hospital 

State Infirmary, Mental Wards . 

Wrentham School 

Monson Hospital 

Miscellaneous 




36 (71) 
161 

19 (91) 
43 (91) 
53 (41) 
72 



(71) 



(11) 



Total number of deaths in State Hospitals in Massachusetts in 1923, fiscal year .... 1,556 
Total number of autopsies performed (24%) 377 

(a) By laboratories independent of Department 252 

(b) By department 125 

1 Done by Department. 



The following table gives data concerning sudden deaths reported to the Depart - 


ment: 








Sudden deaths reported to Depart- 




Epilepsy and asphyxia 


3 


ment ...... 


122 


Fractures .... 


1 


Number autopsied .... 


43 


General paresis or tabes 


3 


Number autopsied by service 


24 


Homicides .... 


1 




Miscellaneous and unknown 


1 


Acute infections .... 


16 


Organic heart disease 


4 


Arteriosclerosis or coronary 


3 


Suicides ..... 


1 


Burn ...... 


1 


Tuberculosis .... 


1 


Carcinoma ..... 


1 


Frost bite .... 


1 


Cerebral hemorrhage 


1 


Ruptured aneurysm . 


1 


Comphcated by fractures . 


2 


Pulmonary edema 


1 


Choked by food .... 


1 


Violence ..... 


1 


Exposure and exhaustion . 


1 


Drugs ..... 


1 


The sudden deaths in the State Hospitals in ten years are herewith presented (either 


autopsied or non-autopsied) : — 








1914 


69 


1919 


. 77 


1915 


85 


1920 


. 84 


1916 


74 


1921 


. 87 


1917 


83 


1922 


. 89 


1918 


117 


1923 


. 122 



a total of 887, of which there have been 442 autopsied or 49.8%. 



Analysis of Autopsied Sudden Death Cases. 

In the years 1913 to 1923 inclusive, there have been 442 autopsied cases. It 
is hereby emphasized in the above chart that the acute infections, 107, or 24 per 
cent of the total, are an important factor in the sudden deaths of our hospital 
population asking for more attention to the physical status of the patient and 
more detailed study of the cases from this angle. It is well known that the unco- 
operative patients are a trial to examine and it is understood that they do not as 
readily call attention to their somatic distresses if they register as such, but it 
seems hardly possible that there could not be discovered an infection which is 
severe enough to cause death, if facihties were at the command of the staff for 
accurate observation. 



P.D. 117. 



17 



The other items of heart lesions, 87, foreign bodies in the larynx, 24, death dur- 
ing epileptic convulsion, 22, the mysterious general paralytic death, 28, the sui- 
cides, 27, tuberculosis, 23, and homicides, 17, and results from fractures, 16, and 
cerebral hemorrhages, 13, are the other items of lesser numbers. Those which 
are inevitable must be apparent on the face of them; others will lessen as vigilance 
increases. 

Analysis, Autopsied Cases (Sudden Deaths). 









to 








o 






to 


















)19-2 








J2 




1 

OS 




1 






1 

00 


1 

o 


1 


CM 


4^ 






















o 




0> 










o» 

T-l 












Heart lesions .... 


4 


9 


13 


13 


16 


5 


8 


4 


11 (11) 


4 


87 


Acute infections 


11 


13 


8 


4 


9 


7 


14 


11 


14 (41) 


16 (51) 


107 


Foreign bodies in larynx . 


3 


2 


7 


2 


2 


_ 


5 


1 


1 


1 


24 


Uremia 


















1 




1 


Epilepsy ..... 


1 


6 


_ 


5 


4 


_ 


~ 


1 


2 


3 (11) 


22 


General paresis 


3 


1 


2 


6 


1 


3 


5 




4 (11) 


3 (11) 


28 


Homicides .... 


3 


3 


3 


1 


2 




2 


1 


1 




17 


Suicides ..... 


3 


3 


1 


3 


3 


5 


5 




3 




27 


Tuberculosis .... 


1 


2 


2 


3 


2 


3 


5 


1 


3 


1 


23 


Fractures ..... 


1 


3 


1 


1 


2 


71 


2 


7 (6') 


4 


1 


16 


Cerebral hemorrhages 






5 




1 




2 


2 


2 (U) 


1 


13 


Thrombosis .... 


2 


_ 




2 




_ 


~ 








4 


After tube feeding 


1 


_ 


1 


1 


_ 


1 




_ 


_ 


_ 


4 


Burns ..... 


1 


1 






_ 


1 


1 


_ 


_ 


1 





Hemorrhage .... 


1 




1 


_ 


2 






1 


_ 




5 


Brain tumor .... 






2 




_ 


2 






_ 


_ 


4 


Asphyxia ..... 




1 




1 


_ 




2 


_ 


_ 


_ 


4 


Katatonic "Hirntod" 






1 


1 














2 


Acute mania .... 


1 


- 




1 


- 


- 




- 


- 


- 


2 


Collapse after bath . 




1 


















1 


Salvarsan 






- 


- 


- 


2 




- 


- 


- 


2 


Fall 


1 




















1 


Edema of brain 


1 




















1 


Arteriosclerosis 


1 










1 


1 






3 (21) 


6 


Ruptured bladder 






1 
















1 


Carcinoma .... 






1 




2 


1 


1 






11 


6 


Drowned .... 








1 










1 




2 


Pernicious anemia . 
























Acute gastritis 






















1 


Edema glottis .... 


















1 




2 


Ruptured spleen 






















1 


Ruptured heart 
















2 




1 


4 


Alcohol 












1 












Thymic death .... 


















2 




2 


Miscellaneous .... 












1 


7 


1 




6 


15 


Totals .... 


39 


45 


49 


43 


51 


33 


60 


26 


50 


44 


442 



1 Fracture complicated death. 



Suicides in State Hospitals. 



1914 




. 9 


1919 


1915 




. 6 


1920 


1916 




. 9 


1921 


1917 




. 12 


1922 


1918 




. 18 


1923 



13 
13 
12 
10 
14 



18 



P.D. 117. 



1922-23. 




-HU5 1 1 1 1 1 1 1 1 


o 




1-1 00 1 1 1 esi 1 1 


CO 


1921-22. 




1 <M 1 1 1 1 ^ 1 1 1 


CO 




1 1 —leo 1 T-( 1 1 1 




1920-21. 




i-"^ 1 1 1 1 1 1 1 1 


(M 




M Tt< r-. 1 1 1 1 _l ^ _( 


o 


1919-20. 




1 CO 1 <-4 1 1 1 1 1-1 1 


'O 




1 coe^ 1 1 1 1 1 1 1 


00 


1918-19. 




ec<M 1 1 1 <-! 1 1 1 1 






r-lT-l 1 1 (M 1 1 e«9 1 1 




1917-18. 




■ri^co 1 1 1 1 1 1 1 1 






CO CO 1 —1 1 CO >-H 1 1 1 




1916-17. 




1 1 OH 1 1 1 1 1 


CO 




(M(M 1 1 1 1 1 1 


CO 


1915-16. 




1 '-I 1 1 1 1 1 1 1 1 


- 




coeo 1 — ii-H 1 1 1 1 1 


oo 


1914-15. 




1 i 1 1 1 1 1 1 . 


CO 




»H(M 1 1 1 1 1 1 1 1 


CO 


1913-14. 




1 <M 1 1 CO 1 1 1 1 1 






>-< 1 1 1 CO 1 1 1 1 1 






Dementia prsecox 

Manic depressive 

General paresis 

Diagnosis unknown i . . . . 

Psychosis with arteriosclerosis 
Alcoholic psychosis 

Constitutional psychopathic inferiority 
Neurasthenia 

Totals 



a 
S 

0) 

■a s 
I ^ 

^ i 

CS M 



•s a 



P.D. 117. 19 



Analysis of 106 Suicides. 



Protestant : 




i^atnoiic — Con. 




American. 




Irish-American 


1 


English . 


1 1 

H 


Canadian .... 


1 


Mixed race 


4: 


Lithuanian .... 


1 


Canadian 


2 


Mixed race .... 


1 


Armenian 


1 


Unknown .... 


1 


Danish . 


1 






German 


1 


. - 

1 urkish Mohammedan 


1 


Irish 


1 






Swedish 


1 


Russian Me brew 


1 


Scotch . 


1 


Religion unknown: 




L/atnoiic; 




American .... 


1 
1 




19 


Rncliah 

JL-iXX^LlOXl ..... 


I 


Italian . 


' ' ! . 4 


Armenian .... 


." 1 


French . 


. 3 


German .... 


1 


Russian 


. 2 


Russian .... 


. 1 


Polish . 


. 2 


Scotch ..... 


1 


English . 


. 2 






American 


. 2 


Nationality and religion unknown 


. 5 



Sex, male 62, female 44, the average age of the male being 43.4 and that of the 
female 42.5. Following are the decades in which these suicides fall: 





11-20. 


21-30. 


31-40. 


41-50. 


51-60. 


61-70. 


71-80. 


Male 


1 


12 


10 


16 


19 


4 




Female 


1 


6 


18 


7 


10 


1 


1 



It is seen by a glance which months are most productive of the suicides in our 
hospitals. 



December . 


. 13 


March 


. 8 


July .... 


. 13 


May 


. 8 


April 


. 12 


January 


7 


June 


. 12 


September 


. 6 


October 


. 11 


August 


. 4 


November 


. 9 


February . 


. 3 





III. Casualties in State Hospitals. 




1914 


346 


1919 .... 


. 208 


1915 


320 


1920 .... 


. 240 


1916 


304 


1921 .... 


. 257 


1917 


237 


1922 .... 


. 258 


1918 


221 


1923 .... 


. 292 



20 « P.D. 117. 

CASUALTY TABLE A. 



Casualties arranged by Institutions. 





Males. 


Females. 


Total 

"NTllTYl V^AT* 

of 

Patients. 


Total 
um ber 
of Ac- 
cidents . 


Total 
Number 
of 

Injuries. 




25 


18 


43 


451,2 


52 




17 


17 


34 


363 


44 




19 


14 


33 


353,2 


47 




20 


9 


29 


29 


34 




6 


19 


25 


25 


31 




10 


14 


24 


24 


27 




5 


14 


19 


19 


22 


Monson Hospital ........ 


7 


9 


16 


16 


18 


Massachusetts School for the Feeble-minded 


9 


3 


12 


12 


15 


Wrentham School 


4 


5 


9 


9 


12 


Gardner Colony 


9 




9 


9 


11 






6 


6 


6 


6 




3 


3 


6 


6 


6 




1 


3 


4 


4 


5 


Boston Psychopathic Hospital 


2 


2 


4 


4< 


5 


Belchertown School 


3 


1 


4 


4 


4 




2 


1 


3 


3 


3 


Ring Sanatorium and Hospital, Inc 


1 


2 


3 


3 


5 








1 


25 


2 






1 


1 


1 


1 




143 


142 


285 


292 


350 



1 Three accidents to one patient. 

2 Three accidents occurred before admission. 

3 Two accidents to two patients. 

* One accident occurred before admission. 
5 Two accidents to one patient. 



CASUALTY TABLE B. 



Casualties arranged by Institutions and Severity of Injury. 





Fractures. 


Dis- 
locations. 


Other 
Severe 
Injuries. 


Total 
Severe 
Injuries. 


Less 
Severe 
Injuries. 


Receivinq Institutions. 












Boston Psychopathic Hospital 


2 






2 


3 


Boston Hospital ...... 


22 






23 


4 


Dan vers Hospital ..... 


31 




2 


33 


14 


Northampton Hospital .... 


2 






2 


1 


Taunton Hospital ..... 


11 


4 


2 


17 


35 




17 






17 


5 


Worcester Hospital 


36 




2 


38 


6 


Institutions chiefly for Transfers. 










19 


Grafton Hospital 


10 




2 


12 


Medfield Hospital ..... 


27 


1 




28 


6 


Gardner Colony 


3 


1 


1 


5 


6 


Foxborouerh Hospital 


5 






5 


1 


State Infirmary, Mental Wards . 


6 






6 




Institutions for the Feeble-minded. 














6 


2 




8 


7 




7 






8 


4 


Belchertown School 


2 






2 


2 


Special Public Institutions. 














17 






18 




Hospital Cottages for Children . 


2 






2 




Special Private Institutions. 














3 






3 


2 




2 






3 


2 












1 




211 


n 


10 


232 


lis 



P.D. 117. 



21 





iiiiiii'-<iiiiii(iiiiiiiiiiiii'-<iiiii^o 


•Itj^idsojj ja^saoJOjW 


e«5|rt-^l 1 IC-ll 1 1 1 1 1 1 1 1 1 1 1 1 ICO(M>CI 1 1 1 I^ICO 


■tnnuo^>'Bn'Bg H'^msi^ 


1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


•[B:>idsojj qSnoJoq^sayW 


-Hl||l|||||C<5III<Mlll|rtl|rtllll|||||l||rt 


•{B^idsoH uo^unex 


(MCOtJ<IMI I<»I |r-(| 1 1^1 1 1 1 l(MI»CI I'rti l-^l 1 1 ICSICOlM 


0(>B^g 'SpJBjW IB1U8J\[ 


IlllllllllllllllllllllfOIIIII—illlllltM 


•ranuo:jt?u'Bg Suty; 


1-1 1 1 1 1 1 1 (N 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


oiqjBdoqo.'Jsj ' uo^sog 


lll^lll'-'lll^ll'-llllllllllllllllllllll 


•m 

-tdsojj uo^draBq^Jo^^ 


Itlllll^lllllllllll'-cllllllllllllll^l 


•{B^idsojj UOSUOJ\[ 


'^llllllllllllli— l||-<*l|||ICOI(MIIIIIIIIIC.)CO 


IB^idsoH piagpajv 


THI 1 1 1— .1^1 1 1 1 1 leOI 1 1 1 1 1 |-.*OJr-(r-<<MI 1 1 1 1 li-HlOS 


IB^idsoH ub8t;oj^ 


-H|r-|||||||.-(|||l|l|||||||ll|||lll|||,-l 


•p9puiin-8|qaaj[ joj 
jooqog ' s;^asnqoBss'Bj\r 


lllllllllllllllltllllll|i-<||||||||COCMO 


JOJ SaSB^J^OQ IB^ldSOJJ 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 C") 


IB^TdSOH UO^JBJQ 


(Ml 1 1 1 1 1(MI 1 1 1 1 l—ll |t-l^| lOT-lr-H.-H| 1 1 1 1 1 1 1 leO 


•AU0I03 jaupjBQ 


lllllll"lllllllllll^ll<MI^IIIIIIIICOI-.H 


[c^idsojj qSnoJoqxoj[ 


llllllllllillllll^lllleoiilliliil-Hii^ 


•{B^TdSOJJ SJaAUBQ 


-H— .esii 1 : icoi 1 1 1 1 1^1 1 1 1 1 1 IOI.-CI 1 i(Mi 1 t I^T->w 


•^B^jidsojj uo'^sog 


lllllllll^llll-Hlllieoil 1 1 1 1 M 1 1 1 1 1 1 <M 


■jooqag u.-vio^iaqaiaa 


lllllllllllllllllllllll'-'llllllll'-xllCv) 




Unknown 

Medical accidmts 

Suicidal 

Homicidal 

Sex assault 

Other motivated act 

Impulsive act 

Reaction to hallucination .... 
Psychomotor excitement .... 

Motor restlessness 

Paralysis 

Arteriosclerotic seizure .... 

Muscular weakness 

Sense defect 

Paretic seizure 

Epileptic seizure 

Epileptiform seizure 

Seizure of other nature .... 

Habitual dislocation 

Asocial acts 

Of another patient 

Of attendant 

Scuffle of patients 

Scuffle with attendant, male 

Scuffle with attendant, female . 

Self-defense 

Retaliation 

Mayhem 

Poisoning 

Occupational 

Machinery 

Farming 

Other 

Unavoidable natural causes 



22 P.D. 117. 

IV. Investigations. 

The pathological evidence of focal infection in the bodies of patients dead with 
epilepsy and dementia praecox is in a state of collection. Until this year many such 
cases had annually come to autopsy; this year a great dearth of such material is most 
regrettable since the wish had been great to investigate such cases and personnel had 
been available to work upon it. However, a start has been made. Every precaution 
was taken to secure tissue to study possible generalized histopathological evidence of 
focal infection in group of insane patients as compared with the control group of patients 
not insane. 

"Four cases of dementia praecox and four cases of epilepsy were studied and repre- 
sentative blocks from the viscera were removed at autopsy and stained with Mallory's 
connective tissue stained for the purpose of demonstrating chronic inflammatory 
changes, hemotoxylin and eosin and Van Giessen stained to demonstrate acute in- 
flammatory and certain degenerative changes and some of the organs were frozen and 
stained with Scharlach R to determine the amount of distribution of fat present, for 
instance, in the adrenals. 

The idea followed in this study was to ascertain if foci of infection are constantly 
found in psychotic patients and then if inflammatory or degenerative changes are 
regularly found that can be attributed to these foci of infection as the etiological factors. 
The difficulty in determining the latter can readily be appreciated when it is realized 
that no definite evidence has yet been brought forth to show the importance that foci 
of infection play in diseases of distant viscera and that for years there has been general 
disagreement among clinicians and pathologists upon this point. However, it was felt 
that if in a large and well controlled series the same or similar inflammatory or de- 
generative changes could constantly be found in patients showing foci of infection and 
not found in patients not showing them, worth while conclusions could be drawn as 
to the relation of foci infection to these lesions. 

Now if a definite relationship can be discovered between foci of infection, and lesions 
of the viscera and if these lesions are peculiar to patients with psychotic manifestations 
as contrasted with non-psychotic patients, the roll of foci infection in producing psychoses 
is established. 

We might say that wfe do find inflammatory or degenerative processes in all these 
cases in varying amounts, but we have no means of knowing whether they are due to 
these infections that are visible and bacteriologically productive or to previous ones. 
The gonadal changes for whatsoever reasons are present in all of the dementia praecox 
patients." Wilson. 

This study will be continued by the Department's new appointee. 

The writer was particularly fortunate in having Dr. D. A. Thom interested in this 
piece of research and in a manner sponsoring and financing it. Dr. B. A. Bartlett, who 
carefully prepared the tissues, so that they could at any moment be photographed. Dr. 
R. B. Wilson, associated with the Department of Pathology at Harvard Medical School, 
who most carefully analyzed the trunk organs, and Dr. Otis F. Kell}^, who used the 
nervous system tissue for controls in his own work on The Acidophile Degeneration of 
the Cortex. 

The Mental Health of the Offspring of Non-Psychotic Parents, published in Mental 
Hygiene, October, 1923, was the third of a series of papers on environmental vs. heredi- 
tary influences on the young, the first by Dr. D. A. Thom entitled "The Offspring of 
the Epileptic", the second by Dr. M. M. Canavan and this third closes for the moment 
investigation of this sort, involving as it does the time and energy of a well trained 
social worker for a period of months. The net results of these investigations show an 
optimistic trend; the epileptic is not so much of a parental risk as was previously 
thought unless two epileptics marry and are alcoholic. Dementia praecox parents are 
not too much of a hazard. Non-psychotic parents cannot be too comfortable, for their 
offspring may turn out to be feeble-minded as often if not oftener than those of the 
above mentioned deviates. 



P.D. 117. 



23 



Comparison of Children of Epileptic Parents, Parents with Dementia Preecox, and 

Non-Psychotic Parents. 





Epileptics. 


Dementia 
Praecox. 


Non- 
Psychotic. 




Echeverria. 


Thorn. 




Canavan. 


Canavan. 




136 


117 


136 


145 




531 


431 


463 


581 




105 


238 


295 


355 


Died 


222 


151 


86 


81 




78 


14 








11 


2 


c 







18 


14 


4 


10 




_2 


_2 


12 


12 




_2 


_2 


12 


12 


Physically diseased 


_2 


_2 


17 


101 


Cases of conduct disorder 






36 


8 



1 One of these cases should properly be classed as pre-psychotic. 

2 These conditions were not discussed in the Thom-Walker study. 



As an evidence of the co-operation between the Department of Mental Diseases and 
the Psychopathic Hospital staff, one might mention the research problem which Dr. 
H. C. Solomon set for Dr. R. B. Wilson during a period of syphilis treatment in that 
department. Dr. Solomon was much interested to know what changes took place in 
the brain substance and in the ventricles after intraventricular treatment of the paretic 
with different varieties of arsenic preparations. Dr. Wilson was fortunate enough to 
find the track of the needle and to study histologically serial sections of the brain along 
this needle track, establishing the rapidity of reaction in nervous tissue to irritative 
foreign body and demonstrating thereby that there seems to be no dearth of reaction 
in brain tissue to injury in the tissue. Photographs and lantern slides were made of 
this study and the subject was made the basis of an illustrated talk by Dr. Wilson 
before the Boston Neurological Club on Dr. Solomon's invitation March 1, 1923. 

The insidious onset of the pneumonias of the insane is emphasized in a paper "Hemi- 
plegias Without Visible Brain Lesions in the Pneumonias of the Insane" and attention 
is called to the necessity of more thorough consideration of the physical illnesses of the 
patients under the hospitals' care. The importance of lumbar puncture, blood counts 
and cultures is emphasized to assist in the diagnosis. 

The mental health of children from dementia praecox stock is also brought to atten- 
tion in a paper by Canavan and Clark on "The Mental Health of 463 Children From 
Dementia Praecox Stock." The comparative table of results is noted under The Mental 
Health of 581 Offspring of Non-Psychotic Parents by the same authors. 

The following table shows the routine work of the investigative staff of the Depart- 
ment: 



Visits to institutions by pathologist ......... 162 

Autopsies in cases of sudden deaths ......... 44 

Severe injuries in institutions .......... 232 

Less severe injuries . . . . . . . .118 

Total injuries ............. 350 

Total number of accidents ........... 292 

Publications of "state officers . . . . . . . . . . .30 



V. Publications. 

AsHMORE, BuELL L., M.D. Comparative Luminal, Bromide, Diet and Eliminative Treat- 
ment of Epilepsy. 
Boston Medical and Surgical Journal, Vol. 187, No. 26, pp. 950-952. 
Bowman, Karl M., M.D., and Grabfiei^d, G. Philip, M.D. Basal Metabolism in Mental 

Disease. Archives of Neurology and Psychiatry, March 1923, 358. 
Bowman, Karl M., M.D., and Grabfield, G. Philip, M.D. A Case of Myxedema in which 
the Basal Metabolic Rate was Minus Fifty-six per cent. 
Journal of the American Medical Association, Vol. 81, No. 3, July 21, 1923, pp. 209-210. 
Bowman, Karl M., M.D. Blood Chemistry in Mental Diseases. 

American Journal of Psychiatry, Vol. II, No. 3, January, 1923, 379-^08. 
Bowman, Karl M., M.D. The Special Relation of the Endocrine Glands to Mental and 
Nervous Disorders. 
Ontario Journal of Neuro-Psychiatry, July, 1923, pp. 5-24. 



24 P.D. 117. 

BowMAK, Karl M,, M.D. The Responsibility of the Psychiatrist in Interesting the Nurse 
in Mental Nursing. (Read at the annual convention of the National League of Nursing 
Education at Swampscott, Mass., June 21, 1923.) Printed in the Annual Report of 
the National League of Nursing Education, 1923, p. 210. 
Campbell, C. Macfie, M.D. Mental Factors in Industrial Hygiene. 

Journal of Industrial Hygiene, August, 1923, Vol. V, No. 4, pp. 130-137. 
Caiupbell, C. Macfie, M.D. The Nervous Child. School and Society, Vol. XVIII, No. 
458, pp. 391-397, Oct. 6, 1923. (Read before the Thirty-Second Annual Meeting of the 
Harvard Teachers' Association, April 28, 1923.) 
Campbell, C. Macfie, M.D. Organization for the Supervision of Mental Defectives. 

British Medical Journal, Aug. 11, 1923. (Paper presented before the British Medical 
Association, Section of Medical Sociology, England, July, 1923.) 
Canavan, Myrtelle M., M.D., and Clark, Rosamond, A.B. The Mental Health of 463 
Children from Dementia Prsecox Stock. 
Mental Hygiene, Vol. VII, January, 1923, No. 1, 137-148. 
Canavan, Myrtelle M., M.D. Hemiplegias Without Visible Brain Lesions in the Pneu- 
monias of the Insane. 
American Journal of Psychiatry, Vol. Ill, No. 1, July, 1923, pp. 81-90. 
Canavan, Myrtelle M., M.D., and Clakk, Rosamond, A.B. The Mental Health of 581 
Offspring of Non-Psychotic Parents. 
Mental Hygiene, Vol. VII, No. 4, October, 1923, pp. 770-778. 
Fernald, Walter E., M.D. What Shall we do with the Feeble-Minded? (Read before 
All-Philadelphia (IJonference on Social Work, April 19, 1923.) Hospital Social Ser\dce, 
VIII, 1923, 57. 

Fernald, Walter E., M.D. The Salvage of the Backward Child. (Read at the Conference 

on Mental Hygiene at Ford Hall, Boston, April 12, 1923.) Boston Medical and Surgical 

Journal, Vol. 189, Aug. 2, 1923. 
Fernald, Walter E., M.D. The Subnormal Child. (Read at a meeting of the Harvard 

Teachers Association, at Sanders Theatre, Harvard College, April 28, 1923.) School 

and Society, Vol. XVIII, No. 458, Oct. 6, 1923. 
Gaunt, George A., M.D. Involutional Melancholia. A Study of 50 Cases at the Worcester 

State Hospital. 

The Journal of Nervous and Mental Diseases, Vol. 57, No. 6, June, 1923, pp. 556-562. 
Grabfield, G. Philip, M.D., and Ai^pers, Bernard J., M.D. The Effect of Iodides on the 
Non-Protein Nitrogen of the Blood. 
Proceedings of the American Society for Clinical Investigation, April, 1923. 
Klrk, a. Dale, M.D. A Lipoma Weighing Two and One-Half Kilograms, taken from the 
inner aspect of the right arm. 
Boston Medical and Surgical Journal, Vol. 187, No. 26, Dec. 28, 1922, pp. 956, 957. 
Klauder, Joseph V., M.D., and Solomon, Harry C, M.D. Juvenile Paresis: With a 
Presentation of Twenty-Three Cases. 
American Journal of Medical Sciences, October, 1923, Vol. CLXVI, No. 4, pp. 545, 558. 
Mohse, Maey E., M.D. Epidemic Encephalitis: A Pathological Study of Five Cases, 
Including Two with Myoclonia. 
Archives of Neurology and Psychiatry, Vol. IX, June, 1923, pp. 751-762. 
Morse, Mary E., M.D. Dementia Prsecox Cases. 

Journal of Neurology and Psychopathology, London, IV, No. 13, May, 1923, pp. 1-26. 
Morse, Mary E., M.D. Two Cases Illustrating the Pathological and Psychiatric Aspects 
of Carcinomatous Metastases in the Central Nervous System. 
Journal of Nervous and Mental Diseases, Vol. LVIII, No. 5, November, 1923, pp. 409-425. 
Peck, Martin W., M»D. An Attempt at Psychogenic Interpretation of Some Familiar 
Disorders. 

Boston Medical and Surgical Journal, Vol. 189, No. 2, July 12, 1923, pp. 52-57. 
Peck, Martin W., M.D., and Wells, Frederick L., PhD. On the Psycho-Sexuality of 
College Graduate Men. 
Mental Hygiene, Vol. VII, No. 4, October, 1923, pp. 697-714. 
Solomon, Harry C., M.D. Value of Treatment in General Paresis. 

Boston Medical and Surgical Journal, April, 1923, Vol. 188, No. 17, pp. 635-639. 
Solomon, Harry C, M.D., Pfeiffer, Henry M., M.D., and Thompson, Lloyd J., M.D. 
Cerebrospinal Fluid Pressures; Concerning an Initial Fall in Pressure Readings and the 
Method of Obtaining a Standard Reading. 
Americjan Journal of Medical Sciences, Vol. CLXVI, No. 3, September, 1923, pp. 341-350. 
Solomon, Harry C, M.D. The Treatment of Neurosyphilis. 

Journal of American Medical Association, Vol. 81, No. 21, November 24, 1923, pp. 1742- 
1748. 

Wells, Frederick L., Ph.D., and Currie, John P., B.S. Time Factors in the Substitution 
Test. 

Journal of Abnormal and Social Psychology, Vol. XVII, No. 4, January-March, 1923, 
pp. 402-404. 

Wells, Frederick L., Ph.D., and Rooney, James S., A.B., A Simple Voice Key. 

Journal of Experimental Psychology, Vol. V, No. 6, December, 1922, pp. 419-427. 
Thompson, Lloyd J., M.D., and Morse, Mary E., M.D., Myoclonic Form of Epidemic 
Encephalitis. (With special reference to Abdominal Myoclonus.) 

The Medical Herald and Electrotherapist, March, 1923. 



P.D. 117. 25 

Summary. 

I. The progress of laboratory work in State Hospitals where they have a pathologist 
is thought to be satisfactory. 

II. A monthly meeting of the pathologists has been held at the Department's 
laboratory. 

III. There have been 125 autopsies during the current year done by the Depart- 
ment's officer and 1,788 during the period from July 1, 1914 to Nov. 30, 1923. 

IV. The analysis of autopsied sudden death cases, 442 in number, shows that 24% 
of the total are due to acute infections against 87 or 19% due to heart lesions. 

V. The suicides for this year have been 14 in number, about the average and analysis 
of 106 cases of suicides which have occurred in the State Hospitals during the past ten 
years shows them to be more frequent in the males than in the females, 62 and 44 re- 
spectively, and that they are more frequently of Protestant persuasion and in the 
6th decade. 

VI. The Medfield State Hospital has the highest percentage of autopsies for this 
current year, namely 44%. 

VII. The casualties for the present year, 292, approach the 1914 to 1916 figures 
when they were highest. 

VIII. The sudden, unexpected and violent deaths have been greater in number 
this year (122) than in any other year since the appointment of your pathologist ex- 
ceeding the year of 1918 when 117 occurred. 

The writer with this report severs State connection and passes on to another field, 
filled with quiet pleasure that no wrench or inconvenience is felt in any way by the 
move, since her successor, Dr. Marjorie Fulstow, will bring trained intelligence and 
enthusiasm into the position. The relations with the hospitals have been most satis- 
factory. To the Commissioner, Dr. G. M. Kline, sincere and abiding thanks and 
gratitude are due and warmly rendered for the confidence and trust he has reposed. It 
has been a most enviable experience in a unique position. 

Myrtelle M. Canavan, M.D., 

Pathologist. 

REPORT OF DIRECTOR OF DIVISION OF SOCIAL SERVICE. 

Reference was made in last year's report to the concentrated effort which had been 
directed toward structural processes in the Social Service Division. With the gradual 
strengthening of the social service structure, new opportunities for service became 
apparent, consequently the past year's efforts have been marked by the extension of 
social service into two more divisions which have been established within the Depart- 
ment of Mental Diseases, — one relating to mental hygiene activities, the other to the 
cornmunity care of non-institutional cases of feebleminded persons. In both these 
divisions, social service plays a large and active part, particularly in the work connected 
with the feebleminded — a problem which is assuming large proportions from economic 
and social viewpoints. 

Institution social service is, apparently, on a sound basis and in a fairly wholesome 
condition: in some instances signs of growth have appeared during the year. The 
nature of the work, which is slowly changing in some respects, is more nearly approach- 
ing the true functions of social service : this is noted principally in the increased number 
of cases which have been referred to social service departments for case work and social 
supervision. There is reason to believe that this change will become more marked as 
the value of social work with mental patients becomes better known to hospital officials. 
The functions of social service will doubtless become as clearly defined and necessary 
as are other recognized branches of hospital service. To some extent this is already 
true of some of our social service departments in State Institutions. There is much 
to be said relative to contributions of social service to medical officials in that they 
must relate directly to values — economic, — scientific — and philanthropic — in order 
to overcome previous misconceptions of social work and to prove by results, more or 
less tangible, that it has much to offer in the reconstruction and treatment of mental 
patients. The necessity of emphasizing the economic value of social work to the insti- 
tution is becoming increasingly apparent and perhaps rightly so — when consideration 
is given to the vast sums of money which are expended annually for the care and treat- 
ment of mental patients and feebleminded persons. 

Social Service: Central Office. 

The functions of the central office, previously defined, remain varied and manifold. 
Although the main functions relate to matters of personnel, organization, policies, cor- 
relation of social work with that of other agencies, publications, etc. — this office is 



26 P.D. 117. 

gradually becoming a sort of clearing house for social agencies and others who wish 
social advice about persons who are mentally affected. Frequent conferences are held 
with executives of other social organizations relative to cases in which mental problems 
are involved. Occasional assistance is requested from other States which are planning 
similar institution service or special work with extramural feebleminded cases. 

Early in the year a new outline for monthly statistical reports was arranged and 
officially adopted after considerable study and effort on the part of various members 
of the Department. These reports cover all the main functions of local departments 
and contain an analytical statement of the work which serves as an aid to constructive 
thinking and planning. Several requests for copies of this outline have been received 
from various parts of the country. 

Two new branches of social service have been started during the year, one in con- 
nection with Habit Clinics of the Mental Hygiene Division, — the other with the 
Community Supervision of Feebleminded persons. The work of the Habit Clinics is 
becoming increasingly popular from the mental hygiene viewpoint, in that it is directed 
toward preventive work with normal children of pre-school age. The social workers 
connected with this clinic are specially trained and otherwise qualified for the work. 

The new law relative to community supervision of non-institutional groups of feeble- 
minded persons opens up new possibilities in State service which are obviously of social 
and economic values, particularly when consideration is given to the costliness of 
institutional care. Without the assistance of trained social workers, it is doubtful if 
such work could be effectively accomplished, therefore plans for such supervisory service 
have included trained personnel. Because of certain necessary changes in the law but 
few persons have as yet been regularly committed for supervision. As a preliminary 
step to the selection of suitable cases for community supervision, a study is being made 
of some 1,400 applications for admission to the Massachusetts School (Waiting List). 
The general purpose of the study is to learn the present status of each application and 
to make recommendations accordingly. Eliminations from this list include — self or 
otherwise adjusted applicants: those in care of other agencies or State departments: 
those for whom arrangements may be made in the community — not located, etc. 
Only those who are in definite need of State care are recommended for commitment to 
institutions or to the Department. Three trained psychiatric social workers are en- 
gaged in this work, which is under the direction of the Social Service Division. Study 
cases are presented weekly for analysis and disposition: social workers from the State 
Schools attend the weekly case reading and take an active part in the discussions. It 
is hoped by this procedure that the community supervision work with the feebleminded 
in Massachusetts may be standardized. There is an increasing number of appeals 
from agencies and other interested persons who seek advice and guidance in this par- 
ticular field which probably further indicates the need and desirability of community 
work with the feebleminded under State direction. 

The following very brief statement indicates something of the nature of the needs 
which the Central Office is attempting to fill. There are numerous requests for social 
advice, guidance or information from various sources relative to the needs of mental 
cases. 

One hundred and eighty-two interviews have been held with hospital social workers 
relative to their work. 

One hundred and sixteen interviews or conferences with persons engaged in some 
other form of social work. 

Forty-eight cases have been referred by social agencies to the Department for definite 
action. 

Seven cases have been referred by the Department of Mental Diseases for special 
investigation or supervision. 

Forty-eight persons have applied for positions — comparatively few of these have 
been able to meet the requirements; several were advised to take a course of training. 

Thirty-five lectures or conferences have been attended outside the Department. 

Seven visits have been made to institutions. 

There are various other duties which naturally fall to an office of this kind. Eternal 
vigilance must ever be the price of building up and maintaining a morale which is quite 
essential in any well functioning social service department. 

Conference Work. 

The regular monthly conferences of Hospital Social Workers have become an estab- 
lished feature of the service. Subjects covered this year are as follows: — 

Outline for Monthly Social Service Reports: Discussions. i i- 

Presentation and discussion of social cases looking toward technic of social case work; poli- 
cies, etc. 



P.D. 117. 27 

Social Aspects of Venereal Disease Work (outside speakers). 

School Clinic Work; joint session with physicians. 

Survey of Social Service Departments — by local social workers. 

Policies relative to Recreation for patients under social supervision. (Some of these subjects 

required two or more sessions.) 
Total attendance at conferences (11 sessions), 300. 
Average attendance at conferences (11 sessions), 27. 

Social workers from State Institutions of New Hampshire and Rhode Island attend 
the conferences regularly. 

Institutional Social Service. 

The following is an attempt to show something of the general status of social service 
in institutions connected with the Department. The functions which have been previ- 
ously defined in other reports remain generally the same — as do many of the routine 
duties which are more or less incidental to general social work. 



Personnel. • 



Institution. 


Social 
Workers. 


Students. 


Boston State Hospital 


3 


2 


Boston Psychopathic Hospital .......... 


51 


1 


Belchertown (feeble-minded) 


1 






2 




Foxborough State Hospital 


1 


2 


Grafton State Hospital 


1 




Gardner State Colony ........... 


1 




Massachusetts School (feeble-minded) 


3 




Medfield State Hospital 


2 






1 




Northampton State Hospital 


1 




Taunton State Hospital 


2 




Westborough State Hospital 


2 




Wrentham School (feeble-minded) 


2 






2 




Division of Mental Hygiene . . . . . . . 


1 


1 




3 





1 Research worker, Psychopathic Hospital. 



Students from Smith College Training School for Social Work are placed annually 
at a few of the institutions for 9 months' practice work under supervision. 

Total number of social workers ....... 34 

Total number of students ........ 6 

Financial. 

The total amount paid for salaries of social workers the past year was S25,955. For 
travelHng expenses incurred in service $6,685, making the total cost of social service 
(aside from maintenance) $32,640 (15 institutions). Students receive no salaries, but 
are reimbursed for travelling expenses connected with the service. 

Numerical Summary of Cases handled by Social Service Departments for the year: — 



Total number of cases considered (all purposes) ....... 11,525 

Total number of cases under social supervision ....... 2,793 

Total number of placements: 

Homes 202 

Industry ............ 73 

Miscellaneous ........... 38 

313 

Total number of visits to patients in homes ....... 4,446 

Total number of visits 10 patients' relatives ........ 6,494 

Total number of visits to employers ......... 2,810 



The above statement refers more directly to the actual case work of the social service: 
other duties include school and community work: history work: lectures to nurses and 
others: and miscellaneous duties more or less directly related to the work of a social 
service department. 



28 P.D. 117. 

Summary of Important Factors. 

Social service has been established in every institution connected with the Depart- 
ment of Mental Diseases. Standards relative to qualifications for social workers and 
students have, to a very great extent, been maintained. New and important work with 
special groups of mentally affected persons has been started which appears to be poten- 
tially valuable and far reaching from social and economic viewpoints. 

The present salary schedule for social workers connected with this branch of State 
service is acting as a deterrent in securing suitable persons for the work. It is becoming 
increasingly difficult to secure or retain desirable social workers under present condi- 
tions. The steadily increasing demand for psychiatric social workers and the inade- 
quate supply of available persons possibly indicate the need of some provision for 
student and volunteer training under Department auspices. 

The interest in Institution social work appears to be gradually becoming a conviction 
that such work is indispensable to State service with mental patients. 

Probably the most valuable and vital features of the present status of our Social 
Service Department are noted in the unity of purpose, on the part of the workers, to 
bring social service to a high degree of efficiency and desirability: a determination to 
emphasize the spirit of social service and its value to patients over the commercial 
evaluation which, in the last analysis, is very difficult to determine. Other compensa- 
tion is frequently realized in the reaction of patients who have been aided in the re- 
adjustment of their lives in the community. This is equally true of the reaction of 
relatives who have worked cooperatively with our social workers. 

Because of the loyalty, support and cooperative attitude of the Commissioner and 
other State officials, the Social Service Division has apparently gained in strength and 
personnel, and possibly in the effective discharge of duties. Estimation of these imseen 
but vital forces is difficult to determine — it must be experienced rather than verbaUy 
expressed to be properly appreciated. 

It is earnestly hoped that the coming year will be marked by progressive measures 
in the various fields in which social service connected with the Department of Mental 
Diseases is now active. 

Respectfully submitted, 

Hannah Curtis, 
Director of Social Work. 

REPORT OF DIRECTOR OF DIVISION OF MENTAL HYGIENE. 

To the Commissioner of the Department of Mental Diseases. 

The Division of Mental Hygiene has carried out the program outlined in the Annual 
Report of the Commissioner of Mental Diseases for the year ending November 30, 
1922, and there is no doubt that the results of the work for the past year have justified 
its existence and has already stimulated other states to follow the lead of Massachu- 
setts in its efforts to prevent mental illness. 

The Division is deeply indebted to the physicians who have given unsparingly of 
their time and effort in directing the problems of research during the past year. 

Dr. Abraham Myerson's research on the problem of Feeble-mindedness, which is 
being carried out in cooperation with Dr. Walter E. Fernald, Superintendent of the 
Massachusetts School for the Feeble-Minded, will be reported within the year. Dr. 
O. F. Raeder's research in endocrinology and its relation to mental deficiency was com- 
pleted and reported at the annual meeting of the Association of the Study of the Feeble- 
minded held in Washington in May. Dr. Harry C. Solomon's studies in relation to 
neuro-syphilis have also been reported and published, while Dr. Myrtelle M. Canavan's 
pathological studies in dementia praecox and epilepsy have been carried as far as funds 
would permit and will be completed during the ensuing year. Dr. A. Warren Stearns 
has made an interesting and valuable contribution to the subject of hornicide. Dr. 
Douglas A. Thorn has completed a study lasting over two years on the relation between 
infantile convulsions and the chronic convulsive conditions of later life. This study 
has been reported and published during the past year. 

In the first report which outlined the program for the Division of Mental Hygiene 
it was stated that "one of the most immediate demands in the State is the organiza- 
tion of Out-Patient Clinics". The Director has personally supervised this activity 
with the idea of supplying every town and city adequate opportunities for getting early 
treatment for mental illness. 

These clinics have been inaugurated during the past year in the following towns: 
Brockton, Worcester, New Bedford, Fitchburg, Lynn, Lowell and Lawrence. A special 
group of clinics interested in the children of pre-school age has been organized and 
developed in the following Boston districts: North End, West End, East Boston and 



P.D. 117. 



29 



Roxbury. Besides these clinics in Boston, Habit Clinics have been opened in Lynn 
and Lawrence and plans are already under way to start similar clinics in Lowell and 

I Springfield. A special diagnostic chnic has been started in Reading in association with 

[ the school authorities. 

In so far as possible the mental clinics have been connected with the General Hospitals 
where the mental and physical side of the individual can be studied as a whole. In 
this way much valuable educational work is being done in association with general 
practitioners, and those interested in medicine and surgery and allied medical subjects 
are in a position to contribute much to the understanding and prevention of mental 
illness. 

The Division of Mental Hygiene rendered valuable service to the various social 
agencies through the State and has been called upon for assistance by practically every 
hospital and social agency interested in problems of health. 

The program for the ensuing year will be carried on along very much the same lines 
as in the past, special attention being paid to the development of the clinical facilities 
throughout the State and the study of such problems, both from a clinical and a labora- 
tory point of view, that have a direct bearing upon the mental health of the citizens 
of Massachusetts. 

D. A. Thom, 

Director. 

REPORT OF THE COMMITTEE ON TRAINING SCHOOLS FOR NURSES. 

The Committee on Training Schools for Nurses respectfully submits the following 
report for the year 1923: — 

Training schools were conducted in nine of the State Hospitals. Thirty-three nurses 
were graduated from six schools. 

The schools were maintained at a standard of high level and we feel that all graduates 
are splendidly equipped to take up the profession of trained nurses. 

The usual difficulty was experienced in obtaining a full quota of pupil nurses. Many 
of those who started the course failed to continue it. The course is very hard and 
requires a great amount of study and extra work. Undoubtedly this is a factor in dis- 
couraging many. Our standards are those of the Massachusetts State Nurses Associa- 
tion and also the Board of Registration in Nursing. The Committee feels these require- 
ments might very well be reduced by eliminating certain subjects which do not appear 
to be essential for the education of a nurse. 

The schools all give one year's affiliation in some general hospital in Massachusetts. 

The courses given attendants have been continued and undoubtedly great good 
has resulted from this instruction. 

The Committee held two meetings during the year with the Superintendents of 
Nurses. Reports were received and various aspects of the work considered. Some 
minor changes in the curriculum and uniforms were made. 

The output of the schools does not seem large, but the Committee feels that though 
few nurses are graduated the fact that a school is being conducted in a hospital is of 
considerable value to the operation of that hospital and, therefore, more than justifies 
the policy of operating schools for nurses in the State Hospitals. 

Respectfully submitted, 

E. H. CoHooN, M.D., Chairman. 

James V. May, M.D. 

John A. Houston, M.D. 

Clarence A. Bonner, M.D., Secretary. 

COMMITMENTS FOR OBSERVATION AND TEMPORARY CARE FOR 

THE WHOLE STATE. 

The number of commitments for observation (under section 77, chapter 123, 
General Laws) was 371 for the year. The period designated by the judges in the 
various cases was usually thirty days. 

Of these cases 217 were subsequently committed, 116 were discharged, 2 were 
admitted voluntarily, 12 died, and 24 were remaining at the close of the year. 

Under chapter 307 of the Acts of 1910, requiring that emergency cases which 
come into the care or protection of the police in Boston be taken to the Boston 
State Hospital for temporary care, and forbidding the use of prisons, jails or penal 
institutions for such persons, 192 were taken to the Psychopathic Department of 
the Boston State Hospital. Of these, 103 were subsequently committed, 69 were 



30 



P.D. 117. 



discharged, 12 were committed for further observation, 1 died, and 7 were remain- 
ing at the close of the year. 

There were 5 admissions under section 55, chapter 123, General Laws, which 
provides for the apprehension of a patient before examination and commitment; 
3 of these were subsequently committed and 2 discharged. There were none re- 
maining at the close of the year. 







Admissions under - 






Section 55, Chapter 123, General 
Laws (Apprehension of Alleged 
Insane Persons.) 


Section 77. Chapter 123, General 
Laws (for Observation). 


Chapter 307, Acts of 1910 (for 
Temporary Care, Boston Hos- 
pital). 


Section 79, Chapter 123, General 
Laws for Temporary Care. 


Section 86, Chapter 123, General 
Laws for Voluntary Care. 


Section 78, Chapter 123, General 
Laws for Care in Emergency. 


Admitted during year .... 


5 


371 


192 


2,611 


304 


59 


Discharged ....... 


2 


116 


69 


733 


204 


5 


Discharged to Immigration Commissioner . 














On visit 








1 


23 




On escape 








2 






Died 




12 


1 


26 


5 


5 


Regularly committed 




215 


1 


893 


24 


16 


Committed for observation .... 


1 




12 


128 


5 


2 


Re-admitted under chapter 174 . 








18 


4 




Re-admitted as chapter 142 . 














Admitted as emergency .... 








50 






Admitted voluntarily 




2 




93 


1 


















Returned to institutions .... 














Committed to other institutions . 


2 


2 


102 


618 


11 


31 


Voluntary to other institutions . 








3 


2 




Non-mental at private institutions 














Remaining September 30, 1923 




24 


7 


45 


25 





Under section 79, chapter 123 of the General Laws, allowing the admission of 
patients for ten days for temporary care, 2,611 cases were admitted, of whom 1,511 
were subsequently committed, 733 were discharged, 2 escaped, 96 received under 
the voluntary status, 1 was allowed to leave on visit, 50 were re-admitted as 
emergency cases, 128 were committed for observation, 26 died, 18 were re-admitted 
under section 79, 1 was admitted as an inebriate, and 45 were remaining at the 
close of the year. 

There were 59 emergency admissions, under section 79, chapter 123, General 
Laws, of whom 47 were committed, 2 were committed for observation, 5 were 
discharged, and 5 died. 

Voluntary admissions numbered 304, of whom 35 were committed, 204 were 
discharged, 23 allowed to go on visit, 5 died, 4 were admitted under Section 79, 
3 went voluntarily to other institutions, 5 were committed for observation, and 
25 were remaining at the close of the year. 

It is to be noted with interest that during the year covered by the report there 
were 304 voluntary admissions, 2,611 under section 79, General Laws, and 192 
under chapter 307, Acts of 1910, making a total of 3,107 patients who were ad- 
mitted without any action of the court or judge or other very formal proceeding. 
Of these 3,107 cases thus admitted, 1,006 were discharged without commitment, 27 
died before commitment, 99 signed voluntary requests, and 25 voluntary patients 
continued their stay in the voluntary status, no commitment being considered 
necessary, making a total of 1,157 persons who secured the benefits of treatment 
in our public or private hospitals for the insane without the formaUty of procedure 



P.D. 117. 



31 



before a judge, which would have been attended with delays, legal exactions, 
semi-pubHcity and the stigma of having been pronounced insane, all of which was 
thus obviated to the comfort and satisfaction of the patients and friends. 

THE STABILITY OF SERVICE 

in the institutions averages about the same as the previous year. There were 
3.18 rotations of all employees, compared with 2.84 rotations the previous year; 
3.96 in the nursing staff compared with 3.49 the previous year. The maximum 
stability for the State Hospital service was at the Danvers Hospital, where there 
were 2.64 rotations; and for the nursing staff also at the Danvers Hospital, where 
there were 2.86 rotations. 

The average length of the interval between rotations of all employees was 3.81 
months; of all nurses, 3.06 months. 

The average shortage of employees was 25.96 per cent. 



1 

1 


i 


i 

\ 






g 2 




CO eoiMcOrt 


CM CO 


Number 
of 

Different 
Persons 
employed. 


ir^_«o CO «o 00 »-<^co ^ o CO lO 


1 §Si§ 


2,012 
9,821 


Average 
Number 
of All 
Em- 
ployees. 




2,390.03 

179.06 
243.15 
184.37 
86.74 


693.32 
3,083.35 


Total Ward Service, 




















Number 
of 

Different 
Persons. 


OOt»<-hCO"5«D^CO?Ot-hCO 


4,739 

338 
514 
435 
52 


1,339 
6,078 


Average 
Number 
of All 
Nurses. 




1,144.41 

88.69 
149.42 
115.21 

33.59 


386.91 
1,531.32 


Female Ward Service. 






COCOC<l(MrttCJ(N'(M-*W* 


3.45 

3.26 
3.15 
3.44 

o on 


3.23 
3.39 


HI 






i| 


Average 
Number 

N 




570.05 

39.24 
68.53 
69.14 
9.96 


186.87 
756.92 


INSTITUTIONS. 












Totals and averages, hospitals and miscellaneous . 
















::::::: ::|:; 


The insane: 

Worcester Hospital . 
Taunton Hospital . 
Northampton Hospital , 


Westborough Hospital 
Boston Hospital 
Psychopathic Hospital 
Grafton Hospital 
Medfield Hospital . 
Foxborough Hospital 
Gardner Colony 

Totals and averages , 
Miscellaneous: 

Monson Hospital 
School for Feeble-minded 
Wrentham School . 
Belchertown School 



34 



P.D. 117. 



THE CAPACITY FOR PATIENTS 

in all the institutions December 1, 1923, was 19,119, compared with 18,652 the 
previous year, an increase of 467 beds. The whole number of patients on Decem- 
ber 1, 1923, was 20,375, compared with 19,529 the previous year, an increase of 
846. There is, however, a deficiency of provision for 1,256 patients, or 6.56 per 
cent. 

THE CAPACITY FOR THE INSANE 

in State institutions December 1, 1923, was 14,654, an increase of 292 beds. The 
whole number of patients on December 1, 1923 was 15,943, as compared with 
15,524 the previous year, an increase of 419. There is, however, a deficiency of 
provision for 1,289 patients, or 8.79 per cent. 



P.D. 117. 



35 



Totals. 


Increase for 
the Year. 


T*<C<|0 1 00 1 t 1 1 OlM 1 1 
r-l T»t W O 

«M 


IM 1 1 »00 

OS CO -I 

CO <N 


•o 


Dec. 1, 1923. 




14,654 

967 
1,498 
1,290 

710 


4,465 
19,119 


Females. 


Increase for 
the Year. 


^lOIIIIIIIC^II 


CO 1 1 >OlO 
CO O 


O CO 


Dec. 1, 1923. 


>0 (M CO «D <35 CO CO Ttl CO CO 1 
«OOCO«0-<*I05»OCOOI:^»005 
05 «D Tf< CO O O lO 03 


CO OlM (M >0 
lO CM -^ti »o «o 
-H lO t— CO 


2,069 
9,222 


Males. 


Increase for 
the Year. 


l<MI 1001 1 1 <OI 1 1 
1— 1 »o O 
CM 


CO 1 1 1 »c 

■rt< o 

CSI r-i 




Dec. 1, 1923. 


eo05coiO'^T^t^-Ht^iooot>-oo 

i-lO>(MtO»0050a5COI>-OOt^O 
^iiO Tti «0 »f5 00 >« O CO «5 f-H 05 


T-H CO OO lO 
O ■'tl IC CO lO 
to 05 »0 CO 


2,396 
9,897 


INSTITUTIONS. 


The insane: 

Northampton Hospital 

Danvers Hospital 

Westborough Hospital 

Boston Hospital 

Psychopathic Hospital 

Medfield Hospital 

Foxborough Hospital 

Gardner Colony 

Mental Wards, State Infirmary 

Bridgewater Hospital 

Miscellaneous: 

Monson Hospital (sane and insane) 

School for Feeble-minded at Waltham .... 
Wrentham School 

Aggregates 



36 



P.D. 117. 



U5 C<« ^ 



03 



§ i2 = 



I CO o <» ec ■ 



1 1>. lO 00 00 



Ob- »o CJ ' 



•t^(M"5(M00 



CO 00 »« O 

eo CO 

»O5O00<M 



OO CO !M O 

l^^ »o 



W 5 15 13) to J 6 XI o w 

' - c 6 <n oZts § S 



<U c 6 en 

- O c3 S 



3 6 o 

3111 

CO 



P.D. 117. 



37 



THE PUBLIC INSTITUTIONS. 

Worcester State Hospital 
Opened in January, 1833. Present capacity, 2,075. 

Valuation of the plant, per capita of capacity, $1,468; real estate, $1,252; 
personal, $216. 

Daily average number of patients on books, 2,496; in hospital, 2,075; in family 
care, 20; on visit or escape, 401. 

Number on books Oct. 1, 1923, 2,579; in hospital, 2,130; in family care, 19; 
on visit or escape, 430. 

All admissions, 647. 

Admissions as insane, exclusive of temporary-care cases, 584. 
First cases of insanity, 462. 
Voluntary admissions, 5. 
Temporary-care admissions, 230. 

Finances, 

Expenditures from maintenance funds, $717,484; total receipts, $83,716, being 
$32,549 from private patients, $47,184 from reimbursing patients, $3,983 from 
other sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.51. 
Weekly per capita cost of whole service, $2.90; ward service, $1.32. 
One person employed for every 6.20 patients; 1 nurse for every 11.34 patients. 
Average monthly wage for all persons employed, $77.29; for nurses, $64.70; 
male ward service, $64.48; female ward service, $64.91. 

Extract from Trustees' Annual Report. 

The three years of Dr. Bryan's service at the hospital have been most successful 
and he has the confidence of the Trustees as well as their active cooperation whenever 
possible. This reason alone, if there were no others, would be sufficient to warrant 
the Trustees in calling the attention of his Excellency and the Honorable Council to 
the policy of the Commissioner of Administration. The budget principle is sound and 
that of cooperative buying but the Trustees concur in the opinion of many who have 
given careful thought to the matter that, while economy in all state affairs is most 
desirable, it is to be deplored that the law, intended to be of great value to the state, 
has been construed and acted upon in such a manner that it has worked out detri- 
mentally, at least to that part of the State's interests coming under the observation 
of the Trustees. 

The present standards of work in Massachusetts cannot be maintained by such rigid 
economy. The care of the patients and the best interests of our institution in every 
way demand that the policies of the institution be formulated by those who under- 
stand the work, who have been trained in such work and know its needs. Cooperation 
should be the watchword in every advance step and special attention should be paid 
to the building up of the morale of the service. This cannot be done on a too limited, 
biased plan. Men of initiative and vision in any direction will not give of their best 
if there is to be no avenue for the working out of those visions, if financial stringency 
hinders the consummation of ideals and warps initiative. The possibility of being 
able to carry out constructive plans is necessary to stimulate and give incentive. The 
best plans, resulting in the best work of not only the Head but of the workers in all 
departments, can often only be made where expense is necessarily involved. The 
cutting now being done on every hand makes for deterioration in effective work. 

Extract from Superintendent's Annual Report. 

A complete re-organization of the medical staff along radically different lines has 
been attempted during the year and while the change has not been in effect sufficiently 
long to be able to say accurately as to whether it is a more efficient way of handhng 
the medical work, we do believe that it has already resulted in better treatment for 
our patients. The medical work has been divided into distinct divisions — Psychiatric 
and Medical. Under the old plan of organization there were two services in the hos- 



38 P.D. 117. 

pital — male and female — each presided over by a senior assistant physician with 
two assistants. These officers were responsible for the entire examination of the patient, 
both physically and mentally. Under the new organization plan a third service has 
been inaugurated, the function of which is the study of the purely physical. This 
service is headed by a senior physician with two assistants and all of the physical 
examinations, both in new cases and patients already in the hospital, are carried out 
by this service. When a patient is admitted to the hospital a preliminary physical 
examination is made by the staff member who receives him. On the third day a member 
of the medical service makes a complete physical examination and is responsible for 
all laboratory procedures and other work connected with the study of the physical 
aspect of the patient. After this work is completed the Psychiatric service then makes 
the psychiatric diagnosis, taking into consideration the physical findings. In this way 
we have been able to find many physical conditions which we have been able to remedy. 
While many of these have no bearing upon the psychosis, it seems obvious that the 
first consideration in any mental disease should be to remedy any existing physical 
abnormality. 

Hydrotherapy Report. 

Our Hydrotherapy Department continues to be one of the most important depart- 
ments in the hospital. We have constantly assigned to this department a hydrotherapist 
and eight nurses on the female side and a hydrotherapist and two assistants on the 
male side. We have made some change during the year in our pack room in the female 
wards and have added five continuous bath tubs. We now have in operation thirteen 
continuous tubs, four on the male side and nine on the female side. These tubs are 
in operation 24 hours a day and the pack room is used the same. 

Psychological Report. 

The most obvious and generally recognized function of a psychological department 
in a State Hospital is the application of mental measurement tests to selected patients 
referred to us by the physicians, especially cases suspected of mental deficiency, court 
cases, and various cases in which there is special need of making the mental examina- 
tion as thorough as possible. It is not necessary that all incoming patients should be 
tested, nor would this be possible with our present working force. But the psychological 
test is a routine procedure in the Out-Patient clinics and the juvenile and adolescent 
subjects who are brought to these clinics for examination are tested with the utmost 
care and thoroughness. 

Unfortunately, we have no adequate means of mental measurement for insane or 
defective subjects. The Binet scale is fairly satisfactory for testing normal children 
and because of its successful use in schools it has come to occupy an important place 
in public confidence. But when used in the clinic it does not yield any such consistent 
results as are generally attributed to it, and we are in great need of a system of mental 
measurement better adapted to clinical requirements. This hospital, including its 
Out-Patient department, offers exceptional opportunities for trying out new methods, 
and the development of a system of tests for use in psychological clinics is probably 
the most valuable contribution our department can make to cHnical psychology. 

Social Service Report. 

The work has been carried on during the year very much as outlined in previous 
reports. Of the 393 cases referred during the year 76 were referred for histories, 56 for 
investigation of conduct disorders, 32 for employment, 19 for investigation of home 
conditions, 24 for investigation of patients' statements, 29 for investigation of state- 
ments of others, 125 for supervision, 6 for care of patient's family and 25 for personal 
service. 

The outstanding social problems in the above cases were disease, sex, personahty, 
environment, education and legal problems. These problems have been solved by 
obtaining better environmental conditions, both in home and industry, bringing about 
changes in point of view and behavior of the patient, adjusting him to his family and 
community and using every available social resource. Much has been accomphshed 
in the homes by educating the patient and relatives in the simple principles of hygiene 
and by giving cheer and encouragement. 

There were at the beginning of the year 23 patients boarded in private families and 
at the close of the year 20 were in family care. The visits paid to this group of patients 
during the year were 84. 



P.D. 117. 



39 



Taunton State Hospital 

♦ 

Opened in April, 1854. Present capacity, 1,204. 

Valuation of the plant, per capita of capacity, $816; real estate, $659; personal, 
$157. 

Daily average number of patients on books, 1,594; in hospital, 1,354; in family 
care, 17; on visit or escape, 223. 

Number on books Oct. 1, 1923, 1,605; in hospital, 1,402; in family care, 14; 
on visit or escape, 189. 

All admissions, 385. 

Admissions as insane, exclusive of temporary-care cases, 355. 
First cases of insanity, 291. 
Voluntary admissions, 1. 
Temporary-care admissions, 112. 

Finarices. 

Expenditures from maintenance funds, $487,017; total receipts, $62,703, being 
$23,799 from private patients, $35,677 from reimbursing patients, $3,227 from 
other sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.69. 
Weekly per capita cost of whole service, $2.95; ward service, $1.18. 
One person employed for every 6.34 patients; 1 nurse for every 12.74 patients. 
Average monthly wage for all persons employed, $78.05; for nurses, $64.96; 
male ward service, $63.27; female ward service, $66.55. 

Extract from Trustees' Annual Report. 

There has been received at the time of making up this report a very beautiful senti- 
ment expressed in the message of His Excellency, Governor Channing H. Cox, which 
was incorporated in the Christmas programs of the calendar year of 1923, and this 
Board desires to express to relatives and friends of patients in this hospital the senti- 
ment contained in the Governor's Message. We feel that the work of the hospital 
will be carried on much easier through the public visitation and familiarity with our 
problems and needs and a sympathetic understanding of the difficulties encountered 
in the care of our unfortunate inmates; also assist us in the economies that are justly 
and rightly used, and testify that the expenditure of special appropriations from time 
to time is most essential to progressive, scientific and humanitarian care of our patients. 

The Training School has been continued under difficulties. Employment of attendant 
nurses, both male and female, seems difficult, and to secure women with the required 
quahfications for entry into our regular training course is increasingly hard to do. At 
the present time we have in our Junior Year but four students, eight are taking their 
course with the affiliated training class at the Boston City Hospital, and only six stu- 
dents are in the coming graduating class. 

Extract from Superintendent's Annual Report. 
Out-Patient Clinic and School Clinic. 

For some years, clinics to supervise the progress of extra-mural cases have been con- 
ducted by this hospital once a month in both Fall River and New Bedford, In April 
of this year, a Mental Hygiene Clinic, operating weekly, and differing from the old 
type of clinic in that any communitj^ cases might be presented to it for examination 
and treatment was opened under the direction of this hospital in New Bedford. 

The personnel of this Clinic, which also operates once a month in Fall River and 
examines cases which are brought to the main hospital for examination without the 
formality of commitment, consists of one physician, two social service workers and one 
psychologist. 

The purpose, as is the purpose of any specialized general hospital out-patient clinic, 
is to accept for examination all of those cases presented to it which fall within its scope; 
to differentiate those cases which are suitable to be cared for in the community from 
those which should properly be hospitalized, and to institute in the former group 
therapeutic measures of a physical, psychiatric, or social nature which would tend to 
modify or entirely eradicate those symptoms which made it necessary for them to be 



40 P.D. 117. 

presented for examination, in order that they be enabled to remain more comfortably 
in the community. 

There have been seen during the year a total of 150 different patients, of these 63 
were male and 87 female. 

The total visits numbered 316, of which 125 were male and 191 female. 



Northampton State Hospital. 
Opened in August, 1858. Present capacity, 858. 

Valuation of the plant, per capita of capacity, $1,458; real estate, $1,215; 
personal, $243. 

Daily average number of patients on books, 1,280; in hospital, 1,045; in family 
care, 9; on visit or escape, 226. 

Number on books Oct. 1, 1923, 1,336; in hospital, 1,080; in family care, 9; 
on visit or escape, 247. 

All admissions, 453. 

Admissions as insane, exclusive of temporary-care cases, 415. 
First cases of insanity, 340. 
Voluntary admissions, 9. 
Temporary-care admissions, 217. 



Finances. 

Expenditures from maintenance funds, $343,100; total receipts, $81,356, being 
$51,458 from private patients, $27,398 from reimbursing patients, $2,500 from 
other sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.19. 
Weekly per capita cost of whole service, $2.55; ward service, $0.83. 
One person employed for every 7.84 patients; 1 nurse for every 19.38 patients. 
Average monthly wage for all persons employed, $86.13; for nurses, $69.69; 
male ward service, $68.11; female ward service, $71.73. 

1 

Extract from Trustees^ Annual Report. 

The high cost of supplies made necessary the most rigid economy. We were enabled 
to turn back into the State Treasury the sum of $36,359.82, but this saving was in 
large part due to a great shortage of employees throughout the year with a consequent 
expenditure for salaries and wages of a smaller amount than was appropriated for that 
purpose. 

Our annual reports for years have called attention to the great over-crowding at our 
hospital and requests for relief have been frequent. The matter is more serious this 
year than ever. Temporary relief has been provided by the frequent transference of 
patients to other hospitals outside our district. But the rehef thus afforded has been 
only temporary. Before another transfer is arranged the overcrowding has become 
more serious than ever and never is the relief adequate. We have at present nearly 
300 patients more than we can accommodate. 

Our Board frequently in our annual reports of the past twelve or fifteen years has 
outlined certain plans that might meet permanently the hospital requirements of the 
four western counties. The plan most favored by us was the estabHshment of a colony 
in Berkshire County where patients from that county and perhaps others from adjacent 
counties might be cared for under the administration and supervision of our hospital 
with the expectation that in time the colony would become an independent institution 
to care for all the patients from its part of the commonwealth. 

It has also been suggested that new buildings be erected somewhere on our hospital 
property in Northampton (which is as accessible as any place in the four western 
counties) near enough to the present plant to make use of its power, heating, lighting, 
cooking, and laundry equipment and its farm. Till within a few years our superin- 
tendent has not favored this plan, believing an institution of not more than 600 inmates 
to be a desirable size. An institution of that size undoubtedly can be administered as 
economically as a larger one, with the incalculable advantage to the inmates and rela- 
tives of a more intimate supervision by staff, subordinate officers, and corps of em- 
ployees. With the growth of our institution to its present size, now maintaining 1,100 
patients, the advantages of the smaller hospital have been lost never to be regained. 



P.D. 117. 41 

There seems then to be no objection to the enlargement of the present institution by 
the addition of five hundred or six hundred beds and our Board offers this plan for con- 
sideration as a possible solution of a very serious matter. 



Extract from Superintendent's Annual Report. 
Medical Work. 

The medical activities of the hospital have been carried on as usual but with a larger 
number of patients to be cared for than ever before and by a staff fewer in numbers. 
In each department, male and female, the medical work and supervision has been 
done by one physician who has had an assistant physician to help him for only part 
of the year. There is difficulty in finding physicians of satisfactory qualifications 
willing to accept service in a hospital for treatment of mental cases because it is so 
unattractive to many. Fortunately there has been no unusual amount of illness 
throughout the hospital. 

The routine analyses, blood and spinal fluid tests, vaccinations against typhoid 
fever, smallpox and the like have been done and antisyphilitic treatments have been 
given in some cases of neuro-syphihs and paresis, but our assistant physicians are over- 
worked and at times are under a strain to accomplish anything beyond the routine. 
They have my sincere appreciation of their loyalty and devotion to their work. 

Care of the patients' teeth has been continued without interruption. A brief report 
of the dentist's work is as follows: alloy fillings, 712; enamel fillings, 118; rubber 
plates, 12; plates repaired, 9; prophylaxis, 793; extractions, 395; treatments, 398; 
treatments completed, 79; gutta percha fillings, 3. 



Out-Patient Service. 

More has been done in the out-patient department than in any previous year but 
fortunately we have had a full complement of workers in this service, a physician, a 
social worker, and an assistant psychologist. 

The nature of the work has been described so fully in previous reports that only 
brief mention of their doings will be recorded. 

Weekly psychiatric clinics have been held regularly at Springfield, Greenfield, North 
Adams, and Pittsfield in turn. Here individuals come of their own accord for exami- 
nation and counsel or are sent by physicians, social workers, associated charities and 
by the courts. Patients out on visit come to report and relatives of patients in the 
hospital come to make inquiries and to send messages back to their friends. Quite a 
number of individuals have been referred to us who were not able to come to the places 
where the clinics are held; these have been visited at their homes. 

It has been our experience that the different charitable agencies have cooperated 
with us in a very helpful way and we learn that our work is highly appreciated in the 
different communities where we serve. Cordial and friendly relationship has been 
established between the hospital and the public and an increasing confidence in our 
hospital has been engendered. 

One day each week is devoted to the Juvenile Court at Springfield by our assistant, 
Dr. Whitney, and has seemingly been of much benefit to the officers of the court who 
have expressed deep appreciation of her services. Requests for similar services have 
come from other courts which we have been unable to grant because of press of work 
on our staff. It is a service that ought to be done and will prove very helpful when 
estabhshed as undoubtedly will be done in the near future. 

The school clinics have been kept busy and there is plenty of work ahead in the 
examination of retarded school children who have been referred to us. Cooperation 
with the school authorities has been excellent where our clinics have been held and 
as methods and purposes are better understood it is found that parents are welcoming 
the new opportunities afforded; there are some communities however from which 
there has been no response and others where the work is being done irregularly by 
methods not prescribed by the Commission. There has been noticed a tendency to 
avoid the necessity of auxiliary classes, if possible, evidently because of the expense 
involved and without due consideration of the value of such classes to the schools, to 
retarded children, and to the community in general. 

Our social worker has had supervision of patients on visit, making frequent visits 
to their homes, assisting in their readjustment to home and community, and advising 
the families as to their physical and mental condition. She attends the clinics, gets 
additional information for our case histories, investigates home conditions of patients 
before coming to the hospital, also prior to their going out on trial visit. Much time 



42 P.D. 117. 

has been spent with social agencies interested in famihes of our patients and in all 
these ways she has assisted the hospitals of the eastern part of the state who have 
patients in our district. 

The attendance at our out-patient clinics has been larger than ever before. The 
total attendance was 677. Of these 34 were referred by physicians, 21 by hospitals. 51 
by charitable and other organizations, 104 by courts, 250 by schools, 13 by other 
patients, 23 came with their relatives, and 20 came of their own accord. Patients 
away from the hospital to the number of 144 reported for the first time and 330 made 
other than first visits. 

The social service department considered 376 cases during the year, of whom 221 
were new ones, 4 were renewals, and 151 were continued from the previous year. One 
hundred and fifty-five cases were closed during the year. 

Danvers State Hospital. 
Opened in May, 1878. Present capacity, 1,532. 

Valuation of the plant, per capita of capacity, $1,881; real estate, SI, 702; 
personal, SI 79. 

Daily average number of patients on books, 2,007; in hospital, 1,642; in family 
care, 16; on visit or escape, 349. 

Number on books Oct. 1, 1923, 2,040; in hospital, 1,650; in family care, 16; 
on visit or escape, 374. 

All admissions, 637. 

Admissions as insane, exclusive of temporary-care cases, 586. 
First cases of insanity, 448. 
Voluntary admissions, 3. 
Temporary-care admissions, 329. 

Finances. 

Expenditures from maintenance funds, $613,516; total receipts, $125,972, 
being $56,327 from private patients, $67,431 from reimbursing patients, $2,214 
from other sources. 

Weekly per capita cost of maintenance computed on net expenses, $7.09. 

Weekly per capita cost of whole service, $2.92; ward service, $1.20. 

One person employed for every 6.54 patients; 1 nurse for every 13.06 patients. 

Average monthly wage for all persons employed, $82.08; for nurses, $67.45; 
male ward service, $67.03; female ward service, $67.86. 

Extract from Trustees' Annual Report. 

The efforts of hospital workers towards rehabihtation, placement, and helpful super- 
vision of paroled patients have been met by a full measure of cooperation on the part 
of local organizations, charitable agencies, and individuals interested in helping the 
handicapped and discouraged. 

The excellent work of our school clinic division has impressed its value upon the 
pubhc whom we serve. Service of this kind, with its common sentiments and interest 
in a cause of almost vital importance to the public, forms the finest bond of union and 
harmony between the hospital and the community. The first fruits of reasoned knowl- 
edge, arising from such an alliance of community and hospital forces, are mutual con- 
fidence and esteem, wholesome consideration for and fuller understanding of each 
other's character and qualities. 

In line with the policy of the Department of Mental Diseases to extend the extra- 
mural activities of the hospitals, arrangements are now under way to establish a mental 
hygiene clinic at the Lynn City Hospital. 

There have been many difficulties to surmount during the year; and doubtless, in 
lesser or greater degree, there always will be difficulties. But the impediments in the 
way of service this year were of a peculiarly trying kind. Curtailments were necessary 
in some departments. Delays in receiving materials and supplies slowed up repair and 
construction work, and in many other ways and directions this embarrassing incon- 
venience was felt. Important repairs and construction work have been held up, as a 
consequence. Fire in our coal pile, and the consequent withdrawal of workers from 
every department interfered with harvesting our crops, and before it was extinguished, 
a greater part of over five thousand tons stored had to be turned over or removed. An 



P.D. 117. 



43 



increased inmate population and an insufficient force of ward workers formed a most 
serious problem of hospital management. The morale of many, outside of the small 
number of old and tried employees, has not been of the best. Agitations and recrimi- 
nations of various kinds, changes and reorganizations and all the other accompaniments 
of rapid, high-pressure wisdom in action upon pubhc affairs, doubtless contributed 
towards general unrest and uneasiness. For these agitations have an effect like unto 
a circle in the water that never ceases to enlarge itself. Their perturbing influence is 
felt throughout the length and breadth of every system which comes immediately 
within the zone of their disturbance, — and, beyond that, in the homes of men and 
women who have an intense personal interest in these institutions because they hold 
and shelter some one preciously near to them. It is a dangerous thing, and yet how 
simple to do, to shatter the faith and confidence of people by reiterated catchwords 
and half-truths which gain a hold in the public mind, and at length come to be believed 
because the highest quarters can do nothing directly to oppose them. 

It was a wise man who said that ''it were good that men in their innovations would 
follow the example of time itself which innovateth greatly but quietly." And the 
observation is impressively applicable as respects State and charitable institutions. 



Extract from Superintendents Annual Report. 
Student Internes. 

The custom of employing undergraduates of medical schools as student internes, 
during the summer months, has been continued. These positions were filled by under- 
graduates of the Johns Hopkins Medical School, the Woman's Medical College of 
Philadelphia, the University of Vermont and St. Lawrence University. The work of 
the student internes was of great value to the hospital. With the shortage of medical 
men, a great deal of work in the laboratory and clinical fields remained uncompleted, 
and this the internes undertook to finish up with commendable zeal and energy. Under 
the supervision of the regular staff they contributed valuable service. 

Public School Clinics. 

The examination of retarded pupils in the pubhc schools was conducted by Dr. Guy 
C. Randall, assisted by Miss Parkhurst, a psychologist, and by the Social Service 
Worker of the Hospital. 

This work is accepted as of great value by school authorities, and parents have come 
to reahze its helpful importance in the cases of backward school children. 



Total number of children examined .... 

First Examination ...... 

Re-examination ....... 

Number referred by schools as three or more years retarded 
Number disclosed to be actually 3 or more years retarded 
Number of towns in which clinics were held for the first time 
Number of towns in which clinics were held for the second time 
Number of towns in which clinics were held for the third time . 
Number of Special Classes established . . . . . 

Number of Special Classes continued . . . . . 



194 
113 
81 
122 
120 
4 
2 
1 
1 
3 



Occupational Therapy. 

The usual classes in occupational therapy and habit training have been conducted. 
The shortage of nurses during most of the year interfered seriously with the routine of 
training in orderly habits the deteriorated class of patients in the wards. 

I have to repeat the statement made in this report last year that "the greatest handi- 
cap to this form of therapy is that the provisions for material, etc. are meagre. Supplies 
for this work can now be obtained only by drawing upon the rather limited appropria- 
tions for 'furnishings and clothing'. Much study and finesse is necessary to fill the 
requirements of these various divisions, and to keep expenditures within our appro- 
priations. There was a time when the occupational department was practically self- 
supporting, and the progress of this form of therapy was the most encouraging feature 
of hospital work. Since the department has been obliged to turn in its receipts instead 
of applying them to its needs, and since practically nothing additional in the way of 
appropriation has been allowed to make up for loss of revenue, this division of medicine 
in the state hospital has suffered a decline, so that a fair description of present condi- 
tions would be that it is carried on not actively, but that it languishes. Something 
better than this is earnestly hoped for." 



44 



P.D. 117. 



Westborough State Hospital. 
Opened in December, 1886. Present capacity, 1,197. 

Valuation of the plant, per capita of capacity, $1,177; real estate, $919; per- 
sonal, $258. 

Daily average number of patients on books, 1,567; in hospital, 1,304; in family 
care, 14; on visit or escape, 249. 

Number on books Oct. 1, 1923, 1,580; in hospital, 1,327; in family care, 10; 
on visit or escape, 243. 

All admissions, 434. 

Admissions as insane, exclusive of temporary-care cases, 407. 
First cases of insanity, 303. 
Voluntary admissions, 10. 
Temporary-care admissions, 93. 

Finances. 

Expenditures from maintenance funds, $530,604; total receipts, $123,000, being 
$83,472 from private patients, $35,162 from reimbursing patients, $4,366 from 
other sources. 

Weekly per capita cost of maintenance computed on net expenses, $7.65. 
Weekly per capita cost of whole service, $3.16; ward service, $1.14. 
One person employed for every 5.97 patients; 1 nurse for every 13.28 patients. 
Average monthly wage for all persons employed, $81.21; for nurses, $65.48; 
male ward service, $63.97; female ward service, $67.12. 



Extracts from Trustees' Annual Report. 

The population within the buildings has remained for several years nearly stationary, 
at somewhat above 1,300 patients. There is, however, an additional number, varying 
at times between 250 and 300 patients, who are out of the hospital, on visit, but still 
under supervision of the hospital in this portion of the State. 

We feel that much has been accomplished in the twelve months just ended, for the 
better care of the patients and for the better physical condition of the whole institu- 
tion. 

It is fortunate that many of the wards, in the main building and in the colonies, have 
verandas connecting with the wards, which enable most of the patients to be in the 
open air, sitting or walking, many hours of each day. Also many of the patients in the 
psychopathic service spend all of the time in bed but still in the open air. And of course 
the tubercular invalids, both men and women, are having continuous open air sur- 
roundings. 

The camp and tent life for about sixty men has been just as popular and satisfactory 
during the summer as in former years. 

It is gratifying to realize that the good influence of this hospital is not hmited to 
this locality. The visits at the hospital each year of the students of Boston University 
School of Medicine are regarded by them as instructive and memorable occasions. 
Some of them come also for several weeks of training in the problems of psychiatry 
and neurology. Some of our former physicians and students have gone to foreign 
lands, and are furnishing intelligent assistance to otherwise helpless sufferers. The 
last one of such representatives is Dr. Mary F. Cushman, a former assistant physician, 
who is caring for 60 to 100 patients daily in Portuguese West Africa. 

We refer to the report of the Superintendent for a statement of the large amount 
of skilled medical and surgical service rendered to our patients by the members of the 
Consulting Board of Physicians and Surgeons and by the visiting Staff. It is difficult 
for any one to estimate the value to the State of the efforts of these specialists, most 
of them residents of Boston and connected professionally with Boston Institutions, 
who are giving of their best even when the State denies them compensation. But in 
so far as we are able, we express in this official way our gratitude for their sacrifices of 
time and private opportunities. 



P.D. 117. 45 

Extract from Superintendent's Annual Report. 
Medical Service. 

Consulting Board. — On February 22nd, the annual meeting of the Consulting Board 
was held at the Hospital. The members discussed with the Superintendent many of 
the problems of hospital management, examined a considerable number of cases re- 
quiring attention, and inspected the wards. Throughout the year the members of this 
board have responded to all calls upon them for their services promptly and cheer- 
fully, and have shown an interest and wiUingness to serve which is keenly appreciated. 

Visiting Staff. — Members of the Visiting Staff have been active in their work 
throughout the year. Our patients have continued to have the benefit of routine 
examination and treatment by these skilled specialists none of whom have failed to 
make their regular visits to the hospital or to come to our assistance when summoned 
for some special emergency. Not only do the patients benefit by the efforts of these 
men in their behalf but the families and friends of the patients are appreciative and 
have increased confidence in our institution because of the attendance of these speciahsts. 

The resident physicians are assigned to assist the various specialists and in this way 
receive special training which qualifies them for carrying out the treatments prescribed, 
and for becoming more skilled in special diagnosis. 

Staff Meetings. — Staff meetings have been held regularly during the year, case 
records have been discussed, and patients examined as formerly. 

Ward Services. — Physicians have made their customary ward visits and a special 
effort has been made to give attention to recoverable cases and to make the wards as 
comfortable and attractive as possible to those who are under protracted hospital care. 
Particular attention has been given to the stimulation of occupation, recreation and 
entertainment for the patients. Careful clinical and laboratory investigation of physical 
illnesses has been carried out, and special diets have been worked out and prescribed 
for those afficted with metabolic disturbances. 

Hydrotherapy has continued to be a frequent and important means of treating out- 
patients. The continuous flow tubs on Childs Upper and Codman Upper and Male 
Ward 4 have been in constant use day and night, and those on Codman Lower, Childs 
Lower and Female Wards 4 and 5 have been used intermittently. Neutral packs to 
the number of 4,365 have been administered. 

The Camp for male parole patients was in operation from June 28th to September 
19th, and as in former years was a great success. There were accommodations there 
for 64 patients and all those who were quartered there were benefited. 

Syphilitic Clinic. — Intravenous injections of arsphenamine in conjunction with 
salicylate of mercury intramuscularly have been given to cases suffering from general 
paralysis of the insane or cerebrospinal syphilis. Physical and mental improvement 
followed in a considerable number of cases. General observation of a considerable 
group of cases causes us to believe that many cases so treated are retarded in their 
progress, fewer patients than formerly become bedridden, and some are able to leave 
the hospital and become wage earners. It is not felt however, that the treatment is 
curative, and it is observed that when such cases begin to fail after a period of quiescence 
the course of the disease is accelerated and the patients pass away without the long 
bedridden stage which was so common formerly. On the whole, both the comfort of 
the patients, the periods of improvement which they experience and the better physical 
condition in which they are kept cause us to believe that this treatment is the best 
available for them. 

Our cUnics are held on Wednesday and Saturday of each week, and the Physicians 
of neighboring towns have been invited to refer syphilitic patients for treatment. Fifty- 
two patients were treated, they receiving 614 doses of arsphenamine and 311 of mercury. 

Psychiatric Out-Patient Clinic. — The usual weekly Out-Patient Clinic was held at 
the Out-Patient Department of the Massachusetts Homoeopathic Hospital in Boston. 
Five hundred and thirteen persons were examined, and given advice or treatment. 

Social Service Department. — The Social Service Department has had a busy and 
successful year. For the first time the Institution has had the advantage of the services 
of two workers, though one position was vacant for a portion of the year. This de- 
partment has charge of all investigations in the community of cases of persons com- 
mitted, secures information for the medical staff in order that it may arrive at the 
proper diagnoses, investigates home conditions prior to the release of patients from the 
hospital where such action seems necessary, obtains employment if possible for patients 
leaving the hospital who are capable of self-support, keeps in touch with patients who 
are absent from the hospital on visit, and adjusts as far as possible unfortunate social 
situations which exist in the homes of those under its direction. It has charge of all 



46 



P.D. 117. 



patients boarded out, and the workers visit regularly the homes of caretakers, and 
check up on the condition of the patients. One of the workers attends the out-patient 
clinic and interviews those reporting and gives such attention as may be necessary to 
the problems of the individual patients. 



Boston State Hospital. 
Opened in December, 1839. Present capacity, 1,897. 

Valuation of the plant, per capita of capacity, $1,894; real estate, SI, 730; 
personal, $164. 

Daily average number of patients on books, 2,411; in hospital, 2,090; in family 
care, 13; on visit or escape, 308. 

Number on books Oct. 1, 1923, 2,462; in hospital, 2,104; in family care, 10; 
on visit or escape, 348. 

All admissions, 613. 

Admissions as insane, exclusive of temporary-care cases, 579. 
First cases of insanity, 447. 
Voluntary admissions. None. 
Temporary-care admissions, 134. 

Finances. 

Expenditures from maintenance funds, $752,997; total receipts, $105,161, being 
$30,829 from private patients, $72,232 from reimbursing patients, $2,100 from 
from other sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.83. 

Weekly per capita cost of whole service, $2.85; ward service, $1.31. 

One person employed for every 6.40 patients; 1 nurse for every 11.70 patients. 

Average monthly wage for all persons employed, $78.86; for nurses, $66.19; 
male ward service, $64.01; female ward service, $68.07. 



Extract from Trustees^ Annual Report. 

The Appropriation for the current year was $731,351.40 for a population of 2,100. 
This was $165,750.44 less than the estimate at the beginning of the year, an estimate 
which was based on the number of officers and employees fixed for the number of 
patients with the established scale of salaries and wages and on the quantities of food 
and clothing allowed for that number of patients. In spite of the fact that there were 
many vacancies in the personnel, that the utmost economy was used, that needed re- 
pairs and improvements were postponed, and that the usual inventory of stores and 
supplies was practically exhausted at the end of the year, the expenditures exceeded 
the appropriation by $21,646.07. This amount has been granted the hospital by the 
Department of Mental Diseases from a general appropriation made for this purpose. 
This hospital has never before exceeded its appropriation, but this year the reduction 
in its estimates was excessive. The trustees question the policy of arbitrarily fixing the 
appropriations at an unreasonably low figure with a supplementary general appropria- 
tion for deficiencies, for if the appropriations are not definite guides for the expenditures 
they cease to have the restraining influence which they are supposed to exert. The 
assumption that there will be a large number of vacancies in the personnel leading to 
an unreasonable reduction in the item of the appropriation for this purpose, must in- 
evitably influence the hospitals to keep the number of officers and employees at so low 
a minimum as to affect seriously the care and comfort of the patients committed to 
their care. 

General Conditions. 

The trustees have maintained their regular visits to the hospital and have seen much 
to commend in the sympathetic interest and care of the patients by the officers and 
attendants in spite of the inadequacy of their numbers. The general health of the 
hospital has been good, and the number of the inevitable accidents less than one might 
expect. 



P.D. 117. 47 

Extract from Superintendent's Annual Report. 
Employees. 

The problem of maintaining an adequate force of employees in the hospital has not 
been so serious as it was during the preceding year. On September 30, 1922, there 
were 386 persons in the employ of the hospital. During the year 822 were appointed, 
685 resigned and 141 discharged. Twelve hundred and eight persons occupied 444 
positions, — a rotation of 2.72. The average daily number of employees during the 
year was 394.96, with 11.89 per cent of vacancies. The average daily number in the 
ward service was 214.56, with 16.6 per cent of vacancies. The ratio of ward employees 
was one to 9.74 patients, and of all employees, one to 5.29. Although this represents 
a slight improvement over the past year, the shortage, especially in the ward service, 
has been such as to interfere somewhat with the efficient and proper care of patients. 
This has affected the medical service in various ways. Less patients have been em- 
ployed and there has been more restraint and seclusion than would be needed ordi- 
narily. The lack of ward supervision, moreover, has resulted in a destruction of clothing 
and other ward supplies that is of considerable importance from a financial point of 
view. The limited number of nurses and attendants has, of course, materially interfered 
with our abihty to satisfactorily handle the large number of visitors calling at the hospital 
to see their relatives and friends. The total number of visits made to the patients 
during the last year was 62,074. We often have 500 or 600 visitors during one day, 
the highest number on any one day during the year being 978. The decrease in the 
number of nurses is, of course, a material factor in increasing accidents, injuries and 
escapes. At the present time there is much less difficulty in obtaining the services of 
male employees. It is still hard, however, to maintain an adequate force of female 
nurses and attendants. This is due, doubtless, in part to the fact that the hours of 
duty are long, and association with mental cases is not attractive to those who are 
not familiar with this line of work. This is a problem, however, which has affected 
the general hospitals as much as it has the institutions for mental diseases. Under the 
circumstances, if an increased compensation is not possible for ward employees, certainly 
no reduction should be contemplated. One of the factors which has interfered with 
our maintenance of an adequate force of ward employees heretofore has been the lack 
of comfortable living quarters. 

Out-Patient Service. 

The supervision of patients in family care and those at home on visit, as well as the 
after care of cases discharged from the custody of the hospital, is an important part 
of the work of the out-patient department. Medical advice also is given to numerous 
persons who visit the hospital for the purpose of consulting members of the staff on 
matters pertaining to their own welfare or that of their family or relatives. The patients 
who have been allowed to go home on visit, or who left the hospital temporarily for 
family care, are visited at frequent intervals by our social workers. Patients on visit 
are also required to report at the hospital at regular intervals for observation. Con- 
siderable supervision is also given to former patients who have been discharged but 
who are kept under observation by the social workers and physicians. Some cases 
appearing for consultation are referred to their family physicians or to the Boston 
Psychopathic Hospital. 

Occupations and Industries. 

Under the direction of Miss Frances E. Wood, the occupational work of the institu- 
tion has continued to increase in extent, 1,069 different patients having come under 
the supervision of this department during the year. Of this number 42 were found to 
be unfit for work in the department; 21 died; 143 improved enough to be allowed to 
go home; 16 were sent to other hospitals, and 62 were benefited sufficiently to be 
capable of working in other departments. The average daily number occupied in the 
male wards was 70, and in the female wards, 178, making a total average daily number 
of 248. The highest number occupied on any one day was 764. At the present time 
we have three occupational therapists on duty at the West Group and one at the East 
Group, in addition to the head of the department. On October 31st one occupational 
therapist resigned to accept the position of head occupational therapist in a State 
hospital in Michigan. During the year nine students from the Boston School of Occu- 
pational Therapy have spent one month each at the hospital for practical experience. 
Eight pupil nurses from the training school have also been given instruction during 
the year, and at the present time three attendants are assigned to the department for 
duty. It is hoped that several more occupational therapists may be authorized in 
order that the work may be carried on more efficiently and a greater number of patients 



48 P.D. 117. 

reached. It is difficult to secure occupational therapists at the rate of pay allowed, as 
other States offer better inducements. A systematic attempt has been made to interest 
in occupation of some kind as many patients in the wards as can be employed under 
existing circumstances, and who are unable, for any reason, to go to the industrial 
room. Occupational work has been carried on during the year in buildings A, B, C, D, 
E, and F in the East Group, and buildings A, B, C, D, F and G in the West Group. 
This consists of basketry, rug making, weaving, lace making, embroidery, knitting, 
crocheting, sewing, mending, furniture repairing, woodwork, simple bookbinding, tin 
work, cord work and drawing. During the year a new class for women has been started 
in a room in the West B Basement, accommodating from thirty to forty. New Classes 
have also been established on the male wards. The quality of work done by the patients 
has improved materially during the year, as has also their attitude towards helpful 
occupations. A year ago patients came to the class-room with reluctance; now those 
who come urge others to ask for assignment. Though the articles made are often of 
no intrinsic value, the patients are much benefited by the encouragement of a return 
of self-confidence, self-control and new and helpful interest. In a few cases it has been 
possible to teach new crafts to men who could use them as a means of livelihood upon 
their discharge from the hospital. The work with deteriorated cases has given very 
gratifying results, the patients having progressed noticeably in every way, and a greater 
number now being occupied. A few of these are able to leave the ward to go to the 
class-room, and most of them take more interest in their personal appearance. We 
have accompHshed during the year all that can be done with the limited number of 
occupational instructors available. A class in cahsthenics would be desirable and 
would doubtless open the way for greater interest and the accomplishment of more 
handicraft work. With additional assistants the work can be more systematically done, 
of much more benefit to a greater number of patients, and of real assistance to the 
hospital, in that the work of nurses and attendants would be decreased, destruction 
still more diminished and a higher grade of occupational work developed. The esti- 
mated value of articles produced in the wards during the year' was $700.00. 

The "occupational therapy center of mental patients", at Hopkinton, established 
under the direction of Miss Marie L. Donohoe, head social worker, during the summer 
of 1922 and made possible by private contributions, has continued its work throughout 
the year. Fifteen different patients have been given convalescent care, their residence 
at the center extending from ten days in some cases to over a year in others. With 
two exceptions, these patients have all shown marked improvement, some of them 
having recovered sufficiently to take their places in the community and live normal, 
helpful lives. Several of them have been enabled to return to their homes, and, while 
not entirely recovered, are doing well, and improving continually. The atmosphere 
at the center is that of a large family, each patient there sharing in the home duties. 
An occupational instructor is employed at the Center one day each week, and the 
work is all graded according to the abilities of the individual patients, ranging from the 
simplest sewing to the highest type of skilled handiwork. The therapeutic aspect of 
the work is not lost sight of in the effort to produce articles of real commercial value 
and the attempt to render the center partly self-supporting. During 1923 nearly S800 
worth of the work of patients at the center has been sold, this representing the amount 
paid to the patients after deducting the cost of the materials. There is a very real need 
for just the sort of care and occupational interest that can be provided for patients in 
centers of the type described, but the hospital can only make a beginning at the present 
time. Repeatedly, cases are referred to the Social Service Department for readjust- 
ment in the community, and many times the homes to which these patients must 
necessarily return are such as to render improvement or recovery impossible. In cases 
of this kind the convalescent center, with its help to readjustment through occupation 
is of great value. It is hoped that the center at Hopkinton may demonstrate its benefit 
to patients to such an extent that with greater facilities in the future other centers of 
this type may be estabhshed and the field covered may thus be considerably broadened. 

Boston Psychopathic Hospital. 
Opened in 1912.* Present capacity, 126. 

Valuation of the plant, per capita of capacity, $5,709; real estate, $5,430; 
personal, $279. 

Daily average number of patients on books, 169; in hospital, 82; on visit or 
escape, 87. 

Number on books Oct. 1, 1923, 142; in hospital, 66; on visit or escape, 76. 



> As a department of the Boston State Hospital. Became separate hospital in 1920. 
« 



P.D. 117. 



49 



All admissions, 1,857. 

Admissions as insane, exclusive of temporary-care cases, 225. 
First cases of insanitj^, 187. 
Voluntary admissions, 129. 
Temporarj^-care admissions, 1,566. 

Finances. 

Expenditures from maintenance funds, $209,159; total receipts, $13,850, being 
$8,520 from private patients, $3,246 from reimbursing patients, $2,084 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $50.92. 
Weekly per capita cost of whole ser\^ce, $30.85; ward service, $7.72. 
One person employed for every 0.67 patients; 1 nurse for every 2.05 patients. 
Average monthly wage for all persons employed, $90.29; for nurses, $68.95; 
male ward service, $62.19; female ward service, $76.62. 

Extract from Trustees' Annual Report. 

The appended reports of the Director and his colleagues reflect something of the 
splendid work which we have occasion to observe. 

We see clearly the great human need that exists for better understanding of mental 
troubles of all sorts and we particularly cherish the fact that side by side with the treat- 
ment of symptoms and diseases there is a steady gittempt to get at fundamentals for 
understanding the disorders of mental life. The members of the staff of the hospital 
are in this respect finely imbued with the best ideals of their profession. 

In these pages and also in the life and work of the hospital as directly seen by us 
there is much evidence of industr>^, of courageous attack upon extremely difficult 
problems, and of admirably sympathetic approach to some of the deepest of hmnan 
tragedies. And running through both the day's work and the year's report there is 
proof of the existence of splendid loyalties and team work. 

Extracts from Director's Annual Report. 
Patients with Serious Bodily Ailments. 

A large number of patients admitted to the Boston Psychopathic hospital have in 
addition to their mental symptoms bodily ailments of the same nature as those which 
are treated in general hospitals. Owing to the complication of the bodily ailment with 
mental confusion or excitement or morbid ideas or hallucinations, the patient is not 
admitted to a general hospital, or he may have been transferred from a general hospital 
owing to the development of the above symptoms. So long as general hospitals have 
no special service for patients with mental disorder, such a transfer to a psychopathic 
hospital will be necessary; but when, in the course of time, physicians and nurses shall, 
in their curriculum, have had adequate psychiatric training, many patients will remain 
in the wards of a general hospital who are at the present time transferred to a psycho- 
pathic hospital. 

One need not refer to cases of pernicious anaemia, tumor of the stomach, pneumonia, 
genito-urinary disease, rabies, etc., but may refer to one group of surgical cases with 
its own special problems, namely to cases where there is actual or suspected damage to 
bones and joints. Cases of suspected fracture are not infrequent, specially in cases of 
depression where the patient, previous to admission, has made an attempt at suicide. 
The surgical condition is of considerable importance to the patient in relation to his 
later economic eflSciency. True economy requires that the equipment needed for the 
diagnosis of such cases be completely satisfactory; the recent provision of a technician 
in the X-ray department has enabled the X-ray apparatus to be used more extensively 
than before, but the roentgenologist finds that satisfactory results cannot be obtained 
unless a connection is secured with the outside current supplied by the Edison Electric 
Company. 

The aim of the staff is to insure for the mental patient, who has a fracture, the same 
facilities for diagnosis, which are at the disposal of those who are mentally sound. In 
this work the cooperation of the consulting orthopaedist is very highly appreciated. 

Among those cases which require special coordination of clinical and detailed lab- 
oratory studies is a group of patients, who present no acute medical or surgical con- 
dition, but whose health is undermined by subtle changes in the glands of internal 



50 



P.D. 117. 



secretion, of which the thyroid gland is the most famihar. The vast importance of 
these glands has only been recognized in comparatively recent years, and this recog- 
nition of their importance has led to an orgy of hypothesis and of treatment, the scientific 
basis for which is still very imperfect. The steady accumulation of accurate data in 
regard to the influence of these glands on temperament and character, as well as on 
the simpler bodily functions is a task which is being steadily pursued in the hospital, 
and to which the Chief Medical Officer is devoting much time and thought. 

To illustrate the range of interests represented at the Boston Psychopathic Hospital 
one may pass from these cases with their very obvious medical aspect to a group of 
cases at the other extreme, where the simple problems of internal medicine play a 
vanishing role, while the difficulties dealt with are so near to familiar problems of 
domestic and social adaptation, that the necessity of a systematic and detailed anal3^sis 
of their origin is frequently not recognized. The study and treatment of the patient 
involve the study of a complex situation, and a wide family group may benefit from 
what statistically appears as the treatment of one individual. 

On the Forms of Report Rendered to Various Organizations. 

In making reports to social organizations, physicians, schools or parents on patients 
with dehnquent behavior the issue is one of health (conceived adequately as the 
health of the total individual), and the practical steps to be taken are to a certain extent 
under the control of the physician, the goal being the elimination of undesirable reactions 
and the development of the constructive forces in the personality. The attempt is 
therefore made in all such reports to lay stress on the actual reactions observed and 
on the mechanisms, which explain these reactions, rather than on terms of formal 
diagnosis, which while pleasing are, apt to have a soporific effect on thought. 

In the case of patients under the jurisdiction of the courts, other issues are intro- 
duced, the disposal of the case is no longer under the control of the physician but is 
determined by complicated extra-medical considerations. The disposal of the case may 
have to be determined according to certain rules and statutes and precedents, and 
these statutes and precedents may have been formulated in terms which are no longer 
appUcable to the real facts of life. Thus the term "insanity", which has practically 
no use as a medical term, save the significance of a disorder, which requires the patient 
to be treated in a State Hospital or under conditions with analogous facilities and safe- 
guards, may have in the special situation to be interpreted in the light of the famous 
McNaughten decision. 

The formulation of a case of sickness in terms with such a connotation, is as reasonable 
as the formulation of a case in terms of "hysteria" or "melancholia," should the 
mediaeval connotation of these terms be insisted on. Words exercise a marked tyranny 
over human thought; the use of such a term as "insanity" inevitably brings with it 
the tendency to consider it as something definite with an existence of its own, a solid 
disease which like an evil spirit possesses the individual and which has to be exorcised. 
While we are sufficiently modern to have substituted glandular extracts (although here 
too a m.ediaeval element survives) and drugs or surgical treatment for exorcisms and 
incantations, we have not altogether emancipated ourselves from the mediaeval attitude 
to mental disorder, and certainly not from the tyranny of words. The term "insanity" 
is by many supposed to represent as definite a morbid process as the term typhoid 
fever, and to be a more or less static condition. 

How far "insanity" is from being a static condition may be seen in the transitory 
episodes of the epileptic, in many cases of alcoholic excitement, and in unstable indi- 
viduals under conditions of peculiar emotional stress and strain. 

On the Problems Presented by Children. 

During the course of the year many children have been studied at the Boston Psycho- 
pathic Hospital, chiefly in the out-patient department, and there is no phase of the 
work at the hospital which is considered of greater importance. The problems pre- 
sented by these children vary widely but many can be grouped under (1) school diffi- 
culties, based on mental retardation, either acquired or congenital; (2) disorders of 
conduct of various type. Among the symptoms found in this second group are truancy 
and wandering from home, pilfering, lying, tantrums, cruelty, various forms of sexual 
activity; (3) in a third group are children presenting evidence of nervous instabihty, 
but in whom there is no evidence of mental defect, nor any disorder of conduct such 
as those referred to above. Among the symptoms met in this group may be mentioned 
disorders of sleep, bed-wetting, tics, morbid fears, minor attacks, disorders of speech. 

During the past few years a number of cases of lethargic encephalitis in children 
have been studied, and a systematic review of these cases is being undertaken in order 



P.D. 117. 51 

to ascertain the later results of this disease, which has only been familiar here in the 
last five years. 

In the study of the children the psychological department offers the greatest assistance, 
working in close contact with the medical staff; the report of the psychologist is not a 
mere statement of "Mental Age" or "InteUigence Quotient," but a brief summary of 
the actual findings, which calls attention to the special abilities or disabilities demon- 
strated. 

The cooperation of the Sick Children's hospital makes it possible to have a thorough 
pediatric review of the physical condition, whenever some special indication makes 
this desirable. 

The study of an individual child, to find the hidden source of neurotic symptoms or 
of erratic behavior, is a prolonged affair, and usually requires repeated visits to the 
out-patient department. 

The treatment of the child, which usually involves the modification of many factors 
in the situation is also a complicated matter. 

Here again it may not be out of place to emphasize the fact that the study and treat- 
ment of the individual child have an influence on a number of people in contact with 
the child, and bring before the social worker important principles of child psychology. 

On the Number of Patients Cared for. 

In the preceding sections, the attempt has been made to give very briefly a concrete 
picture of some of the work done in the wards and in the laboratories, so that bloodless 
statistics and classiflcations might get some life. The statistics, however, give some 
indication of the extent of the problem; although the hospital has only 110 beds, 
almost 2,000 patients are admitted annually to its wards. The study and treatment of 
these patients, as has been emphasized, have to be compared with the like medical 
activities in a general hospital, and the expense is obviously very much higher than 
that of caring for large groups of chronic patients, which forms such an important part 
of the responsibility of the ordinary state hospital. In addition to the large number of 
patients treated in the wards of the hospital, one has to consider approximately 1,000 
patients who receive advice and treatment in the out-patient department. This de- 
partment under the direction of Dr. Peck maintains a high level of efficiency, and 
constant thought is given to methods for making the out-patient diagnosis and treat- 
ment as systematic and thorough as the special conditions of this type of medical con- 
sultation allow. The progress achieved during the past year has been most gratifying. 



Grafton State Hospital. 
Opened in October, 1877. Present capacity, 1,154. 

Valuation of the plant, per capita of capacity, $1,449; real estate, $1,244; 
personal, $205. 

Daily average number of patients on books, 1,502; in hospital, 1,448; in family 
'care, 7; on visit or escape, 47. 

Number on books Oct. 1, 1923, 1,507; in hospital, 1,454; in family care, 11; on 
visit or escape, 42. 

All admissions, 26. 

Admissions as insane, exclusive of temporary-care cases, 26. 
First cases of insanity, 18. 
Voluntary admissions, 1, 
Temporary-care admissions, none. 

Finances. 

Expenditures from maintenance funds, $513,707; total receipts, $17,875, being 
$1,825 from private patients, $10,404 from reimbursing patients, $5,646 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.74. 
Weekly per capita cost of whole service, $3.04; ward service, $1.04. 
One person employed for every 6.19 patients; 1 nurse for every 14.81 patients. 
Average monthly wage for all persons employed, $81.24; for nurses, $66.51; 
male ward service, $65.92; female ward service, $67.13. 



52 



P.D. 117. 



Medfield State Hospital. 
Opened in May, 1896. Present capacity, 1,540. 

Valuation of the plant, per capita of capacity, $1,272; real estate, SI, 131; 
personal, $141. 

Daily average number of patients on books, 1,780; in hospital, 1,694; in family 
care, 7; on visit or escape, 79. 

Number on books Oct. 1, 1923, 1,774; in hospital, 1,699; in family care, 6; 
on visit or escape, 69. 

All admissions, 55. 

Admissions as insane, exclusive of temporary-care cases, 47. 
First cases of insanity, 36. 
Voluntary admissions, 2. 
Temporary-care admissions, 24. 

Finances. 

Expenditures from maintenance funds, $579,823; total receipts, $31,792, being 
$2,776 from private patients, $24,896 from reimbursing patients, $4,120 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.53. 
Weekly per capita cost of whole service, $2.78; ward service, $1.17. 
One person employed for every 6.45 patients; 1 nurse for every 12.56 patients. 
Average monthly wage for all persons employed, $77.59; for nurses, $63.93; 
male ward service, $63.87; female ward service, $63.98. 



Extract from Trustees' Annual Report. 

Conformity to statute requirements and individual humanitarian efforts, have con- 
stituted only the details of the work of the Trustees. Visitations to the hospital have 
been regular; inspections have been thorough; conferences with officers and patients 
have had the merit of frankness possibly only on a basis of mutual friendliness. Under 
the leadership of Superintendent Elisha H. Cohoon, M.D., and his capable staff, the 
administration of hospital activities has been so efficient that statistics corapiled in 
accordance with Massachusetts hospital standardization, exhibit this institution favor- 
ably. We call attention to this achievement with gratification. 

Occasionally it seems necessary to give support to the Superintendent in his efforts 
to secure from the Commonwealth some additional equipment. Our Board is unanimous 
in its belief that lack of such facilities as adequate occupational rooms, causes the de- 
tention in the hospital of many patients for unnecessarily prolonged periods, resulting 
in needless suffering and great cumulative cost. Incorporated with the report of the 
Superintendent, under the headings of "Maintenance" and "Special Appropriations," 
will be found lists of needs. We have scrutinized every item on these hsts and we 
solicit careful consideration by those to whom the duty of recommendation for appro- 
priation may be assigned. Attention is also invited to what we believe to be a notably 
good record in the management of funds appropriated in previous years for special 
purposes. 

Steadily increasing appreciation of the requirements for successful performance of 
the diversified duties of the resident staff of officers has caused the Trustees to study 
methods of preserving the general principles of hospital management and develop- 
ment. 

Conditions at this hospital are known to officers of the Commonwealth to be the 
result of modern methods administered by a progressive Superintendent, who is sup- 
ported by a sympathetic Board of Trustees. These Trustees have observed various 
methods in several hospitals. They are now firmly attached to a pohcy of unfettered 
scientific leadership for the care and cure of the insane. When psychiatrists of un- 
questioned rank have definitely determined the most effective means to alleviate mental 
suffering and cure the mentally sick; when psychologists have determined the relation 
of the state of mind of physicians, executive officers, nurses and attendants to the 
successful application to the patients of the psychiatrists' prescriptions, then business 
efficiency experts may render valuable service. Such business allies might devise ways 
by which the needs of the patients would be most economically supplied. With una- 
nimity we offer our loyal support to such a program. 



P.D. 117. 53 

Extract from Superintendent's Annual Report. 
Medical Work. 

The orderly routine work was conducted with perhaps fewer interruptions than 
usual. The acquiring of a pathologist with excellent clinical laboratory experience, 
served to excite a healthy interest in the physical clinical side of the work. 

An effort was made to study every case of physical illness and mental illness from the 
laboratory standpoint as well as from the ordinary clinical standpoint and an attempt 
was made to attain that ideal where it is felt that every possible treatment is given 
to the individual case. 

The PubHc School Clinics were carried on with the same excellent results that 
characterized this work last year. 

We were fortunate in not having epidemics of any kind and the general health of 
the hospital has been good. 

During the year 25 patients and employees were given major surgical attention. 

Dr. George O. Clark of the consulting staff, as usual, voluntarily responded and per- 
formed the majority of these operations. Other surgical work was conducted by Dr. 
Harold Tobey, Dr. Ernest Hill, and Dr. Jason Mixter. 

Training School for Nurses and Employee Problem. 

The usual difficulties were encountered in obtaining sufficient apphcants for the 
training school. A class of only two was graduated but there was an average class of 
juniors. The increase in pay, granted June 1, has had its effect in getting more appli- 
cants for the course to begin in October. It would seem that probably the increase in 
pay rate will result in larger classes. The standard of the school has been maintained 
and there were no failures in either class taking the examination. As compared with 
other schools their standing was relatively high. 

The number graduated each year might seem to scarcely warrant the maintaining 
of a school, but I am convinced that the fact that a school is being conducted goes a 
great way toward keeping up the standard of the whole nursing service. 

During the early and late spring there were indications that it would be very difficult 
to obtain an adequate force of ward employees, both from the standpoint of numbers 
and quality. The material increase in the pay rate certainly was a boon and since 
June 1, when this went into effect, the help situation as it relates to the wards, domestic 
and dining room and kitchen services has greatly improved. We are now enabled to 
actually select and there has been a corresponding improvement in the general morale 
and standard of care. 

The one department where great difficulty was experienced in keeping an adequate 
quota was that of repairs. The higher rate of wages obtaining outside for carpenters, 
masons and painters caused us to lose some of our oldest and best mechanics and the 
repair work correspondingly suffered. Unless outside conditions change very soon I 
believe it will be necessary to increase the pay schedule for mechanics if we expect to 
keep the repair work of the hospital up to standard. 

Farm, Garden and Grounds. 

During the year 1922, there was such an excessive fall of rain that it interfered with 
the growth and care of some of the farm and garden crops. During the past year there 
were drouth conditions, yet despite this the results from the farm and garden have 
been very good. Hay and corn were not large crops but there was an unusual crop of 
potatoes. Aside from onions the garden products were up to the average in yield. On 
the whole, our farm activities have resulted in a material saving to the State. 



Gardner State Colony. 
Opened in October, 1902. Present capacity, 841. 

Valuation of the plant, per capita of capacity, $1,241; real estate, $985; per- 
sonal, $256. 

Daih^ average number of patients on books, 923; in hospital, 852; in family 
care, 48; on visit or escape, 23. 

Number on books Oct. 1, 1923, 969; in hospital, 893; in family care, 46; on 
visit or escape, 30. 



54 



P.D. 117. 



All admissions, 66. 

Admissions as insane, exclusive of temporary-care cases, 50. 
First cases of insanity, 39. 
Voluntary admissions, 1. 
Temporary-care admissions, 28. 

Finances. 

Expenditures from maintenance funds, $320,227; total receipts, $14,485, being 
$3,908 from private patients, $5,013 from reimbursing patients, $5,564 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.67. 
Weekly per capita cost of whole service, $3.15; ward service, $1,08. 
One person employed for every 6.11 patients; 1 nurse for every 13.91 patients. 
Average monthly wage for all persons employed, $79.45; for nurses, $62.92; 
male ward service, $63.42; female ward service, $62.06. 



Extract from Trustees^ Annual Report. 

During the year the Board has met with an irreparable loss. Dr. Herbert Howard, 
the Chairman of the Board, died suddenly at Lynchburg, Virginia, March 6, 1923, in 
the sixty-eighth year of his age. Dr. Howard had been connected with the public and 
private institutions of Massachusetts nearly the whole of his life since graduation from 
the Medical School. He had been Superintendent of the State Infirmary at Tewks- 
bury, the Resident Physician of the Massachusetts General Hospital, Superintendent 
of the Peter Bent Brigham Hospital, member and Chairman of the State Board of 
Insanity, and Chairman of the Trustees of the Gardner State Colony. 

Dr. Howard had been connected with the work of the State Colony from the very 
inception of the plan for its foundation. He was largely concerned in selecting the site 
of the Colony, the separate parcels of which were bonded and later purchased by Mr. 
George N. Harwood, of our Board. Dr. Howard's wisdom and great experience have 
been given freely to the Commonwealth of Massachusetts in many directions, but the 
outstanding proof of it is this fine institution at Gardner. The Trustees wish to record 
their grief and sense of the very great loss in Dr. Howard's death. 

Dr. Frederic A. Washburn has been appointed by Governor Channing H. Cox to 
the vacant place on the Board. 

During the year our new Hospital has been completed and open for patients. It is 
a most valuable unit of our buildings. It has already been a great relief and comfort 
to our patients and officers. The new laundry, which also has been completed and is 
in use, proves very satisfactory. A considerable section of new road between the 
Colony and the City of Gardner has been built by cooperation between the City and 
the Institution. The occupation of the new laundry has made it possible for us to 
start the changes in the domestic building. These are well under way and we should 
soon have our enlarged kitchen, bakery and dining rooms. 

The Colony has had a very trying time this Summer and Fall because of lack of 
water. There has been risk from fire, and the supply at one time was so low that the 
necessary economy in the use of water endangered the comfort and health of the patients. 
The ordinary supply of water of the Colony is insufficient and in time of drought this 
is reduced to an alarming degree. The Trustees have called attention to this matter 
in their annual reports of 1920 and 1921, and have repeatedly urged the situation upon 
the central authorities in additional communications. It is earnestly hoped that there 
will be no failure to provide the necessary connection with the Gardner or Ashburnham 
water supply this coming Spring. 

Next to an adequate water supply the most pressing of these needs is the second on 
our list. It is very important for the comfort and happiness of our patients that this 
request should be granted. The colony now has an Infirmary building for men and 
one for women, holding about one hundred and seventy-five patients each. Patients 
committed directly from their homes to the Gardner State Colony, of whatever type 
they may be, must be taken into these buildings. Patients transferred by other hos- 
pitals are admitted here until study enables us to classify them. In addition, patients 
in our Colony groups who become for one reason or another unsuitable for the colonies 
must be cared for in these Infirmary buildings. The aged and the infirm must be 
housed here. We have here, then, all types from the quiet recoverable kind to the 
chronic disturbed type. The aged and infirm and less troublesome patients should not 



P.D. 117. 



55 



be kept in the same building with the semi-disturbed patients. It is not fair to them 
so to do. It is for these reasons that we earnestly recommend that we be granted the 
second of these requests. If it is impossible to give both buildings at the same time, 
at least let us have one during the coming year. 



Extract from Superintendent's Annual Report. 

In submitting this report of the year I would review briefly the general development 
of the Colony thus far, considering the purposes and expectations expressed at the 
time its origin was conceived by the Commission appointed in 1898 to consider the 
state-wide problem of the care of the mentally ill and defective in Massachusetts, which 
leads to a consideration of the development which followed during the ensuing years 
since its establishment in 1900, and its opening in 1902 to the present year, to a review 
of the work of the present year and a statement as to future development. 

This review has repeatedly suggested itself to me because of the death of our Chair- 
man, Dr. Herbert B. Howard which occurred on March 6. It is well to note that Dr. 
Howard more than any other, early saw the advantages of a colony, and not only urged 
this as a member of the Commission appointed in 1898, but eventually selected the 
site upon which our Colony was built. Dr. Howard's interests were state-wide, but as 
keen as any was his interest in the Gardner Colony. I have never known a better in- 
formed hospital executive. One never gave more willingly of his knowledge and broad 
experience than he. The State has lost a citizen and hospital administrator of the highest 
type, the Colony the benefit of his association and wise counsel, while those of us who 
knew him best feel that we have lost one of the best of friends. 



The Colony System, 

as recommended by the Commission in 1898, very clearly stated in considerable detail 
the needs of the State at large, the Colony system being recommended as merely one 
part of the program. The full report shows in the light of subsequent state-wide de- 
velopment, the keen insight the members of this committee had and the mapping out 
of a plan of meeting these needs shows after these years their depth of knowledge, 
insight, and foresight. 

The part of their report which dealt with Colony care pertained largely to the estab- 
lishment of this institution and our subsequent development has closely approximated 
the original conception. 

The Development 

from 1902 to 1907 consisted of the construction of a central administrative group of 
buildings, two of which were for the reception of patients, and two colony groups from 
which farms were to be developed. From 1907 to the present year eight additional 
colony homes or groups have been added in which are housed those patients who, as 
a rule, are quiet, but who will need continued hospital care. About these farms have 
been developed, or within them occupation has been encouraged. Occupational build- 
ings have been erected and from time to time cottages for the housing of employees. 
Such buildings have been erected by our own labor. 

Previous to 1919 patients were received, by transfer only from other hospitals, but 
in addition to this the Colony is now a reception hospital for its prescribed district, 
and this year has received approximately the same number by direct admission as by 
transfer. The reception of patients direct from their homes has served materially to 
stimulate the interest in the general medical service without lessening of interest in 
those patients suffering from a more chronic type of mental illness, indeed, I believe 
it is helped by it. 

Progress Made. 

Occupation as treatment was one of the principal reasons for the establishment of 
this Colony. From the first this has been our chief interest that the individual patient 
might benefit thereby, and that all might benefit from the result of their combined 
efforts. Productive occupations for adults have always, with us, aroused greater 
interest than sense or senseless training. Making something to be used (as cloth, 
clothing, furniture, etc., raising farm products) is a normal occupation and is of the 
same and frequently greater value to our patients than to those persons in the com- 
munity who are regularly engaged in these constructive efforts. In addition to our 
industries and occupations of previous years, we have added weaving of sheeting, 
making of games, toys, puzzles, etc. Sheep raising has been stimulated and from this 



56 P.D. 117. 

we are now receiving creditable returns in meat and wool. We have made from the 
wool our blankets, sweaters, shawls, mittens, etc. Co-operating with the Department 
of Mental Diseases, printing has been further developed. A larger room has been set 
aside for this, two larger presses installed and we are undertaking to do all printing for 
the fifteen hospitals under the Departm.ent. Pottery has a special appeal for many 
and this is being developed along practical lines. 

Mention is especially made of creative occupations from which the Colony and the 
individual benefit directly and indirectly for the reason that we believe so strongly in 
this. Diversional and invahd occupations, do, however occupy an important place in 
treatment and have been utilized as formerly. 

Cures directly resulting from any occupation or diversion are not easily obtained 
and should not be rashly claimed. It is not easy to demonstrate improvements in 
those whose disease tends to progressive deterioration as directly and only due to 
occupational treatment. Improvement seen is frequently the result of a number of 
methods of treatment all of which have been beneficial. It is, nevertheless, clear that 
individuals who are regularly occupied and whose interests are stimulated have less 
tendency to indulge in abnormal activities, are more normal in their behavior and 
personal care and are better physically. It is, therefore, only fair to claim that the 
deteriorating agencies, so Httle understood, must be thereby to a degree counteracted. 

The Future 

development of the Colony in order that it may become, in fact, a district hospital 
serving in full the needs of the district, but still retain Colony features, would seem 
to require extension in two directions: A. Provision should be made for proper classi- 
fication of those we now have and those who are to be admitted. B. Extension of the 
Colony plan for additional numbers. 

A. At present those who are admitted are of necessity received in the hospital 
building intended for the sick or in the Infirmaries in which classification is already 
unsatisfactory. Two buildings for those requiring special treatment because of their 
active mental condition would remove from the Infirmaries those who now serve to 
disturb those recently admitted, the infirm, and the otherwise quiet. If this provision 
were made the present Infirmary buildings would serve as such, but to them could be 
admitted the new patient of the quiet type. Eventually, a reception service should be 
provided equipped for the treatment of acute mental illnesses of all types, thus allow- 
ing the Infirmary buildings to accommodate only the infirm, the number of which is 
steadily increasing. 

Two additional buildings accommodating ten each, similar to two we now have, 
would permit of proper treatment of the acutely disturbed. It is not fair to any type 
of patient that they be cared for in the Infirmary buildings as classified at present. 

B. Additional Colonies: The simple comparatively inexpensive type of Colony 
buildings we now have serve admirably for the care of the quiet continued care cases. 
As the need of the State for greater accommodation of numbers demands it, other Colony 
buildings may very readily be added at a low cost and without appreciably increasing 
the general official organization. The ultimate number of such colonies would be 
limited only by the need of additional provision, not by lack of suitable building sites. 

School Clinics. 

Examination of School Children whose names have been submitted by the Superin- 
tendents in our district as three years retarded, has been carried on in Fitchburg, 
Gardner, Ashby, Lunenburg, Townsend and Winchendon. The total number of cases 
examined was 119. Of these, 116 were found by intelligence tests to be three or more 
years retarded. Reports were sent to the school superintendents on all cases with 
recommendations as to their grade classification and physical handicaps. The per- 
centage of cases without handicaps has been practically nil. In the above towns we 
have received good cooperation especially after the work was in progress and the super- 
intendent more thoroughly understood its scope. There are, however, apparently 
because of misconceptions on the part of the superintendents or because they have no 
room to care for special classes, a few districts in which we have been unable to make 
a survey. In isolated cases some superintendents have been unwilling to submit names 
of children who are manifestly retarded for fear of offending the parents. We feel, 
however, it is only a matter of time when full cooperation of both parents and local 
school authorities will be general. 



P.D. 117. 



57 



FoxBOROUGH State Hospital. 
Opened in February, 1893. Present capacit}^, 649. 

Valuation of the plant, per capita of capacity, $2,179; real estate, $1,893; per- 
sonal, $286. 

Daily average number of patients on books, 649; in hospital, 564; on visit or 
escape, 85. 

Number on books Oct. 1, 1923, 661; in hospital, 569; on visit or escape, 92. 
All admissions, 150. 

Admissions as insane, exclusive of temporary-care cases, 131. 
First cases of insanity, 102. 
Voluntary admissions, none. 
Temporary-care admissions, 67. 

Finances. 

Expenditures from maintenance funds, $309,614; total receipts, $19,099, being 
$4,926 from private patients, $12,178 from reimbursing patients, $1,995 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $10.48. 
Weekly per capita cost of whole service, $4.51; ward service, $1.45. 
One person employed for every 4.49 patients; 1 nurse for every 11.19 patients. 
Average monthly wage for all persons employed, $87.90; for nurses, $70.64; 
male ward service, $70.72; female ward service, $70.56. 

Mental Wards, State Infirmary. 
Opened in October, 1866. Present capacity, 673. 

Daily average number of patients on books, 726; in hospital, 723; on visit or 
escape, 3. 

Number on books Oct. 1, 1923, 725; in hospital, 712; on visit or escape, 13. 
All admissions, 37. 

Admissions as insane, exclusive of temporary-care cases, 37. 
First cases of insanity, 33. 
Received by transfer, 16. 

Bridgewater State Hospital. 
Opened in September, 1866. Present capacity, 908. 

Daily average number of patients on books, 877; in hospital, 862; on visit or 
escape, 15. 

Number on books Oct. 1, 1923, 899; in hospital, 876; on visit or escape, 23. 
All admissions, 79. 

Admissions as insane, exclusive of temporary-care cases, 79. 
First cases of insanity, 65. 

MoNSON State Hospital. 
Opened in Ma}^, 1898. Present capacity, 967. 

Valuation of the plant, per capita of capacity, $1,064; real estate, $826; per- 
sonal, $238. 

Daily average number of patients on books, 1,239; in hospital, 1,109; on visit 
or escape, 130. 

Number on books Oct. 1, 1923, 1,247; in hospital, 1,089. 

All admissions, 174. 

Insane admissions, 17. 

Sane epileptics admitted, 157. 

First cases of epilepsy, 120. 



58 



P.D. 117. 



Finances. 

Expenditures from maintenance funds, $372,640; total receipts, $19,408, being 
$9,228 from private patients, $7,980 from reimbursing patients, $2,200 from other 
sources. 

Weeklj^ per capita cost of maintenance computed on net expenses, $6.44. 
Weekly per capita cost of whole service, $2.95; ward service, $1.24. 
One person employed for every 6.18 patients; 1 nurse for every 12,48 patients. 
Average monthly wage for all persons employed, $79.07; for nurses, $67.51; 
male ward service, $65.39; female ward service, $70.17. 
The general statistics for the year are as follows: 



P.D. 117. 



59 



1 





Totals. 


1,239 


o CO ^ ^ ' o 


' o ^ 




Totals. 


Females. 


<M 

<M 

<o 


<M »« -H 00 CO C5 

o 


1 >o 


o CO 
cot>- w 

<£> 




Males. 




OO 00 1 «o ot<- 

«0 CO O .-1 5S| 

^ — 1 1-- 


1 


1 CO CO •«f 

«« o 

■■£> 



s CO I I Ti 1 I O O CO 



1 2 

g'5 



c 
«- o 



O (C 



g 2 § 

lis 



o s ox: — 

o sit-?. Is 



fl c O 

.5 3 c c 

to 02 CO fcl 



o o 

«- o o 

MO O 

C J- M 

!?> ^ £ 

.2 « 
,"0 



CO 



60 



P.D. 117. 



Extract from Trustees^ Annual Report. 

The acquisition of four cottages for physicians has helped us very much toward 
insuring that continuity of service of assistant physicians, so necessary for best results. 
The main difficulty we now are experiencing is not new, except in degree: It is over- 
crowding. We have had too httle room for housing of patients for some time, but, 
reahzing the inopportuneness of the past two or three years, have refrained from making 
harassing requests for funds during that period when retrenchment was being attempted 
along all lines. 

It now seems, however, that we soon must have more room; that another building 
for patients is urgently needed. We think the building should be one of capacity to 
care for at least 100 patients. Such a building could be used as a receiving hospital 
for the use of both male and female patients. Patients could be received and for a 
time domiciled in this receiving hospital until a study of their cases was completed 
and a satisfactory classification made. On the completion of this study and classifica- 
tion they could be sent to their proper places for care and treatment. We think this 
building will not only relieve the overcrowding but will add a very desirable unit to 
our group and that it will effect an economy in operation and be a benefit to our charges. 



Extract from SuyerintendenV s Annual Report. 

The average number of patients during the hospital year has been 1,108.88; the 
number of patients admitted 174; the number of deaths 85; the average number of 
patients who have been out on a visit during the year 130.80. 

The laboratory has been in charge of Dr. Leslie H. Wright, Pathologist, who has 
carried out some important research work in addition to the ordinary laboratory 
routine. 

The out-patient work has been carried on during the past year and the scope greatly 
enlarged. 

The general health of the patients has been good during the past year. 



Massachusetts School for the Feeble-minded. 

Opened in October, 1848, Present capacity, 1,498; at Waltham, 1,183, at 
Templeton, 315. 

Valuation of the plant, per capita of capacity, $991; real estate, $823; personal, 
$168. 

Daily average number of patients, 1,555. 
Number Oct. 1, 1923, 1,576. 

Finances. 

Expenditures from maintenance funds, $541,892; total receipts, $18,905, being 
$9,437 from private patients, $6,015 from reimbursing patients, $3,453 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $6.70. 
Weekly per capita cost of whole service, $2.92; ward service, $1.38. 
One person employed for every 6.35 patients; 1 nurse for every 10.34 patients. 
Average monthly wage for all persons employed, $80.53; for nurses, $62.16; 
male ward service, $62.87; female ward service, $61.31. 
The general statistics for the year are as follows: 



P.D. 117. 



61 





]Vl3.1©S 


■T emales. 


Totals. 


Number present Sept. 30, 1922 


947 


658 


1,605 


Admitted during the year . . 


384 


164 


548 


School cases 


71 


31 


102 




138 


83 


221 


By transfer 




1 


1 


From visit ........... 


109 


43 


152 


From escape 


3 




3 


Nominal admission from visit 


51 


6 


57 




12 


~ 


12 


Whole number of cases within year 


1,331 


822 


2,153 


Dismissed within the year 


402 


175 


577 




81 


16 


97 


Capable of self-support 


21 


4 


25 


Improved 


39 


5 


44 


Not improved .......... 


14 


4 


18 


No change . . 


7 


3 


10 




14 


10 


24 


Transfer 


122 


91 


213 


On visit .... 


174 


58 


232 




11 




11 


Number present Sept. 30, 1923 


929 


647 


1,576 


State 


913 


637 


1,550 


Private 


16 


10 


26 


Daily average number of patients for the year 


909.70 


645.85 


1,555.55 


Number at school Sept. 30, 1923 


685 


647 


1,332 


Number at Templeton Sept. 30, 1923 


244 




244 








671 



Extract from Trustees' Annual Report. 

Early in the year the trustees succeeded in purchasing a large meadow between 
Eliot and Brook Colonies at Templeton, thus eliminating the chance of an objectionable 
neighbor in the midst of our property. It was paid for from the funds of the Corpora- 
tion as no appropriation was available. 

We have begun paroling under the provisions of Chapter 337 of the Acts of 1922 
described in our last report. Agreements have been prepared to be signed by the 
child and the parents, and one by the superintendent stating that the individual is 
paroled by the trustees. The latter acts as a permit for the parole, and having the 
child sign something has a good effect upon him. 

The Christmas festivities were unusually good and there was much interest through 
the long winter in out-of-door sports, skiing, coasting and skating. The children look 
forward with keen anticipation to the celebrations that come from time to time during 
the year — and they are all very happy while they last. We do not think we can refer 
too often to the beneficial effect upon our inmates of the personal interest the doctors, 
teachers and attendants give to these children deprived of the blessings of home life — 
which too often the normal child takes as a matter of course. Competition in sports 
and in industrial pursuits, has the same interest for these boys and girls that it does in 
life at large. It differs in degree. Our showing in industrial pursuits has fallen off 
somewhat since the war and the coming of parole. The brighter ones are missing for 
they are out on parole. 

Despite our handicaps much progress has been made in the year. One of the most 
interesting, satisfactory and valuable industries is the canning plant, details of which 
will appear in the superintendent's report. We often wonder if the careful planning 
and the successful work which results in an institution like this, is appreciated or even 
recognized by the public at large. The quiet, unostentatious daily training of these 
inmates of low mentality results in saving many thousands of dollars to the taxpayers 
of the State. When we read the Statistics of how much is expended by the Common- 
wealth in the care of its dependents, we doubt if many realize how much more would 
be needed but for the conscientious and effective service of the heads of these Institu- 
tions. Like the debt we owe to the faithful and efficient teacher in the pubhc school 
is the debt we owe to the men and women who try to make useful members of the 
Community, the inmates of our State Schools. 



62 P.D. 117. 

Since July 1st we have had many distinguished visitors from eighteen of the States 
of the Union extending from New York to California, from five foreign countries and 
from Canada. We all remember the impression made upon the British Commission 
several j'-ears ago when it spent considerable time at the School and at the Templeton 
Colony. 

The^ Massachusetts School for the Feeble-Minded is more than an institutional 
collection of buildings for the care of the Feeble-Minded. Its needs are more than food, 
clothing and housing accommodations for its inmates. It was the pioneer in the proper 
care of the Feeble-Minded. It is today turned to from at home and from abroad, for 
advice and assistance in the problems which it has mastered. 



Extract from SuperintendenV s Annual Report. 

Transfers to the Belchertown State School. — During the year 143 patients were trans- 
ferred to the Belchertown School; 91 females in March and 25 females and 27 males 
in October. The homes of these patients are in the western part of the State. Many 
of these were of our older settled patients, splendid working boys from Templeton 
Colony, and efficient, docile boys and girls from Waverley. Many of them had been 
at the School for many years. 

The discharge of many adult working patients and younger adjusted boys and girls 
and the admission of 350 persons, mostly children, untrained and more or less uncon- 
trolled, have made this a very busy year. Our Schools are filled wdth pupils who have 
had little training or control. Many have been mischievous and resentful of authority 
at home. They are beginning at the very bottom of the school ladder. Few are now 
able to do anything except the most elementary manual work in the industrial depart- 
mxent. But they are already interested and promising and will soon be proud of their 
accomplishments. The quality and efficiency of our population is still further reduced 
by the parole of so many of "the trained older pupils. We dismiss our successes and 
naturally accumulate those not so successful. The most promising and well-behaved 
defective children are now kept at home to attend the special classes in the various 
cities and towns. We advise and encourage this arrangement. The troublesome and 
difficult ones are sent to the State Schools. Our task is to make the most of this waste 
product of human life, to make them as happy as possible, to keep them well physically 
and to develop them to the limit of their natural endowment. 

We have ample playgrounds and the children spend the most of their life out-doors. 
They live in clean, warm and well ventilated buildings; they have good clothing and 
comfortable beds; they have an abundance of good food. Our herd of 85 tubercular 
free cows furnish over one ton of clean fresh milk each day. Our farms, gardens and 
orchards furnished large quantities of summer and winter vegetables and fruit this 
year. We raised 789 barrels of apples, 6,000 bushels of potatoes, etc. Our cannery 
this year put up 11,513 gallons of vegetables which will greatly vary and enrich the 
patients' dietary until the next harvest. 

Afier-Care and Social Service. — The Social Service Department of the School gives 
as much supervision and assistance as possible to former patients of the School who 
are now at liberty in the community. 

One hundred and eleven males and 38 females, a total of 149, have been formally 
paroled under the Parole Law of 1921. Practically all of these are at work for regular 
wages. They all report to the School at regular intervals. They are very glad to come 
back and proudly tell about their work, wages, savings, etc. Almost without exception 
they are conducting themselves properly. A few younger boys, perhaps too young for 
parole, with innately mischievous tendencies, have been troublesome at home but have 
committed no serious offenses. Two of the girls, with previous immoral experiences, 
have disappeared. The others have done well. The parole principle has fulfilled our 
expectations thus far. 

There are 86 patients at home on visit and on trial, absent less than one year, who 
have been given as much oversight as possible. Many of them will probably make a 
satisfactory adjustment at home and will remain there and will be discharged. Others 
will be paroled and remain for a long time under the supervision of the School. No 
attempt will be made to retain those who are doing well and have good homes. 

During the year 316 former patients who have been discharged have been visited, 
their famifies and friends interviewed, and appropriate advice and assistance given. 
These patients and their families almost invariably are glad to see the visitor from the 
school and are grateful for the interest shown in their welfare. 



P.D. 117. . 63 

The homes of the patients where friends wish to take them out for the summer vaca- 
tion are visited to determine the suitabihty of such a vacation. Last summer 460 such 
requests were made and 369 patients were given a vacation. Of these all but 35 were 
promptly returned. 

Altogether our social service visitors made 1,040 visits in connection with the com- 
munity care of the patients in the above groups. They also procured the social histories 
of all the patients examined in the Waverley Out-Patient Clinics and have made all 
the detailed arrangements for the School Chnics in the various cities. 

The continuing friendly interest of the visitors from the School seems to be a very 
potent factor in making it possible for these boys and girls to support themselves 
happily in the community instead of being supported permanently at State expense. 

Social Service for Applicants for Admission. — All the applicants for admission are 
now referred to the social service division of the Department of Mental Diseases and 
are regularly visited and advised and assisted by trained visitors from that Depart- 
ment. So that now to merely ask for admission to the School ensures that the State 
will provide much needed oversight until they can be admitted or until they are properly 
adjusted at home. 

Waverley Out-Patient Clinic. — The Out-patient Clinic held at Waverley on Thursday 
of each week dealt with 681 patients during the year; 337 new patients were examined, 
and diagnosis was made and detailed advice given; 155 patients returned for subsequent 
visits; advice was given by letter and telephone in 191 cases. 

Of the 337 new cases thoroughly examined, the following diagnosis was made: 

Feeble-minded 247 

Not feeble-minded ......... 62 

Diagnosis deferred ......... 28 

337 

Of the 247 diagnosed feeble-minded, other conditions were seen as follows: 16 were 
of the "Mongolian" type of defect; 10 were delinquent; 8 were microcephalic; 8 
were epileptic; 6 were hydrocephalic; 6 were psychotic; 6 were syphilitic; 5 showed 
difficulty with ductless glands; one was a cretin and in one the mental defect followed 
an attack of "Sleeping sickness". 

Of those diagnosed as not feeble-minded, two were superior normal persons; 28 
were normal; in 8 the abnormality of the ductless glands was the principal diseased 
condition; 3 were epileptic; 3 were insane, 16 were inferior or backward rather than 
feeble-minded and in 2 cases it was a question of behavior and not of mentality. 

The advice given was as varied as the patients themselves. In general the parents 
or guardians were advised as to the details of home care and training and general social 
supervision. In many cases letters were written to the teachers of the children indi- 
cating the level of school work which would be reasonably expected. Special medical 
care was often recommended. The most important thing is to have the parents under- 
stand the boy or girl and not expect too much. 

School Clinics. — The "Traveling School Clinic" of this school has examined 1,568 
retarded pupils in the public schools of the twelve cities and towns assigned to our 
school, as follows: Danvers, 53; Fall River, 256; Gloucester, 31; Lawrence, 114: 
Lowell, 76; Lynn, 34; New Bedford, 307; Revere, 157; Salem, 68; Waltham, 109; 
Watertown, 65; Worcester, 298. 

The diagnosis of 1,568 pupils examined was as follows: Feeble-minded, 1,122; Back- 
ward or borderline, 149; Diagnosis deferred for later examination, 221; Not feeble- 
minded, 76. 

The above very inadequately describes the great variety of mental, physical, moral 
and emotional problems which were found in this group of children who were three 
or more years retarded in the public schools. 

Forty-one presented definite symptoms of inadequate functioning of the ductless 
glands; twenty-four were markedly neuropathic; eighteen were diagnosed as consti- 
tutional psychopathic inferiority; nine were epileptics; four were of the Mongolian 
type of defect ; four had chorea ; five were apparently developing actual mental disease ; 
two were insane, in both cases from injury in automobile accident; two were hydro- 
cephaHc; two were cretins; two were hemiphlegic; one was suffering from "Sleeping 
sickness". 

It is worth noting that among this large number examined, only thirty were reported 
as being markedly delinquent, and of these only five presented imminent sex problems. 

Almost without exception these 1,568 pupils needed expert medical attention, for the 
treatment of impaired nutrition, for trouble with eyes, ears, throat, teeth, for the treat- 



64 . P.D. 117. 

ment of nervous conditions, enuresis, tuberculosis, etc. Nearly every pupil needed in- 
struction as to personal hygiene and habits, hours of sleeping, diet and exercise. The 
families were urged to refer the children to their family physician as soon as possible. 

The following additional towns have recently been referred to the TraveUng School 
Cluiic of this school for the next year: Acushnet, Barnstable, Bourne, Dennis, Dart- 
mouth, Fairhaven, Falmouth, Freetown, Mashpee, Sandwich, Somerset, Swansea, West- 
port, Yarmouth. 

A few years ago we were concerned only with the pupils in the School who remained 
here for many years as a rule. From the foregoing description of this year's work it 
will be seen that this year the School rendered service to 4,789 mentally defective 
persons, as follows: 



School patients at beginning of year ....... 1,725 

Admitted during year .......... 350 

Advised at Waverley out-patient clinics ....... 681 

Advised in Waverley school clinics ........ 1,568 

Paroled patients reporting regularly ....... 149 

Former patients supervised at home by our Social Service Department . 316 



Total 4,789 



The cost of the service to all these persons is included in the regular expenses of the 
School. 

Defective Delinquents. — The commitment of a few male defective delinquents to the 
special department for defective dehnquents at Bridgewater had an immediate and 
permanent effect upon the morale of the School. Unfortunately this provision cares 
only for males over 17 years. We have a small group of boys from 10 to 16 years who 
were difficult and incorrigible at home and who cannot be adequately dealt with in a 
school for feeble-minded. We also have a large group of female defective delinquents 
who do not belong here and who should be cared for in a special institution as provided 
by the Law of 1911. They are criminal women and girls and need a form of discipline 
and a sort of housing which would not be appropriate in this School. Their influence 
on the ordinary defective is very demoralizing. 

Clinical Teaching at the School. — During the year 76 clinics or clinical lectures were 
given to physicians, teachers, nurses, social workers, medical and college students, 
normal school students, and other similar groups. This involves a great amount of 
work on the part of the staff of this School. 



Wrentham State School. 
Opened in June, 1907. Present capacity, 1,290. 

Valuation of the plant, per capita of capacity, $1,117; real estate, $930; personal, 
$187. 

Daily average number of patients, 1,228. 
Number Oct. 1, 1923, 1,235. 

Finances. 

Expenditures from maintenance funds, $470,046; total receipts, $6,105, being 
$856 from private patients, $2,038 from reimbursing patients, $3,211 from other 
sources. 

Weekly per capita cost of maintenance computed on net expenses, $7.34. 
Weekly per capita cost of whole service, $2.70; ward service, $1.28. 
One person employed for every 6.66 patients; 1 nurse for every 11.14 patients. 
Average monthly wage for all persons employed, $78.12; for nurses, $59.28; 
male ward service, $61.36; female ward service, $57.89. 
The general statistics for the year are as follows: 



P.D. 117. 



65 





Males. 


Females. 


Totals. 




Number present Sept . 30. 1922 ........ 


442 


802 


1,244 


^QUlJldtfU »> ibim* i/iJC jf ......... 


171 


158 


329 


By commitment 


84 


80 


164 


By transfer 


29 


41 


70 


From visit 


21 


22 


43 


From escape . 


11 




11 


"Nlrkminollx^ from Visit 


15 


14 


29 




11 


1 


12 


Wbole number of cases within year 


613 


960 


1,573 


Dismissed within the year 


120 


121 


241 


Discharged 


35 


24 


59 


Transferred 


76 


83 


159 


Died 


9 


14 


23 


On visit Sept. 30, 1923 


92 


109 


201 


On escape Sept. 30, 1923 


28 


3 


31 


Number present Sept. 30, 1923 


440 


795 


1,235 


Daily average attendance for the year 


434.41 


794.04 


1,228.45 



Extract from Trustees' Annual Report. 

While hardly to be noted of any one year, because it is a development rather than 
a revolution, it is unmistakable that the place of an institution for the care of the feeble- 
minded in relation to the community, by which and for which it is maintained, has 
undergone marked change even within the period of this school's existence, and may 
triUy be said to still be in progress. One feature of that progress has previously been 
commented upon in our reports. It is the understanding of the school as a place of 
training rather than custody. Not that this conception of the dual obligations of the 
institution for this class of the state's dependents was original with the establishment 
of Wrentham, for it had earUer origin even though the design for this school distinctly 
bore the marks of the constructive rather than the simply detentive purposes, but that 
there has been a clearly discernible shift of emphasis from restraint to training in the 
service to the mentally handicapped. 

Actually this notion of the purpose of the state institutions is no more than a re- 
assertion of the initial thought of that American pioneer on the treatment of the feeble- 
minded, Dr. Howe, and that has been upheld and exemplified in the high-minded policy 
of the man who has supplied to the state and the world his many years of statesman- 
like leadership, Dr. Fernald. 

There has been secured a steady advance in policy towards the ideals of these 
recognized leaders. But the public thought has had to come through the development 
from the regard of the state's duty as one of removal of the mental unfortunates from 
the community to a place of confinement, up to the making that place of restraint the 
seat of a thorough going training of such faculties as the charges could be found to 
possess with a view to their usefulness and happiness and, — in the latest development 
of pohcy, — their possible return to the community with a measure of equipment for 
self-care and contribution to the common fund of social well-being. 

The other broadening concept of such a school takes in the use of it as a radiating 
point of instruction and service to the community in extra-institutional help of the 
handicapped. The medical staff of the school comes to have another concern than 
that as to the care and treatment of those who are committed to it. The thought of its 
members reaches out to and their service comes to include, a direct contact with the 
people of the Commonwealth. There is established the very tangible service of the 
clinic, which finds its welcome place in centres of population. The talent and pro- 
fessional and practical training of these experts turns to account in interpretation of 
public purposes and in direct exposition of the personal application. By example and 
discussion the professional resources of the school come to the service of the community. 

It is this service of the Wrentham State School which marks the latest step in the 
direction of greatest possible usefulness to the Commonwealth. It stimulates the 
greater self-reliance of the cities and towns in dealing with the problems of retarda- 
tion. It aids in prevention of future burdens to the state and so it makes all the more 
valuable the maintenance of an ample and highly expert staff at the school. The school 
comes more to be regarded not as an institution set apart but as an integral part of the 
community. 



66 P.D. 117. 

A great gain has come to the school in the removal of the defective delinquent older 
boys to the Department at the State Farm. Such a school as ours, suffers enormously 
by the presence in its population of defectives of a distinctly criminal type. That fact 
was realized when they were present, before the special institution was provided. It 
is realized even more fully by the contrast their absence supplies. 

Up to the present time the transfers of the defective delinquent number only 27 
boys. That is a small fraction in an institution with 1,300 inmates. But the relief is 
out of all proportion to the number transferred. It is realized even beyond what was 
predicted that this sort of charge is a menace to the property of the state, a disturbance 
to the regular order, an undue absorbent of the attention of the administration, an 
upsetting of the morale, an interference and an influence the mischief of which does 
not depend upon numbers. The worst effect is that it makes it difficult for the orderly 
feeble-minded boys or girls to live their own lives and to gain the value that the school 
may be to them. 

This presence, so far as Wrentham is concerned, has still to be spoken of in the 
present tense. The boys removed were all 17 years of age or older, owing to that being 
the minimum age for admission to Bridgewater. The distinction by physical age is 
theoretically unsound in relation to persons who are taken into the state's care on the 
basis of a mental age. It is practically unwarranted as experience with the same sort 
of boy under the age limit arbitrarily fixed painfully proves. Given, say, a nine year 
mental age plus a criminal slant, and it does not matter perceptibly whether it is im- 
planted in one of a physical age of fourteen or eighteen. The outcome, in every item 
that makes the misplacement in a school hke this objectionable, is not different in its 
menacing and disturbing effect. If what has been accomplished both for the bo3^s 
themselves who are proved to be rightly placed in a special colony, and for the school 
which has profited greatly by relief from their presence, justifies the new classification, 
it may positively be taken as showing the importance of making provision for the 
physically younger boys in the same institution with the older ones or elsewhere. They 
are as badly and as evidently out of place in the feeble-minded school as the older 
ones. 

The same instructive experience points the way to the segregation of the defective 
delinquent girls. There is the same background of disturbance and evil influence in 
their case, the same daily experience which compelled the removal of the boys. There 
is, as well, the same logic of gain to the disturbing girls to be secured by placing them 
where discipline can be more rigid and where the complex of a criminal disposition with 
a mental inferiority can have a specialized attention. As trustees of the state's interest 
in the school and the community problems it has to deal with, we again urge the re- 
moval of these girls and all the more strongly because we observe the gain that has 
come from the partial carrying out of the plan. It is essential that there should be 
complete detachment of such a colony from the school for the feeble-minded. In our 
judgment it should be completely away from the neighborhood so that there could be 
no possible intercourse either of inmates or attendants. 

Extract from Superintendent's Annual Report. 

The schools have been successfully maintained throughout the year with increasing 
interest on the part of both teachers and pupils with the result to be desired — that of 
progress by the children in all departments of the school. 

The curriculum is arranged to meet the needs of the children and, therefore, has a 
wide range, embracing the most rudimentary sense training for the lowest grades on 
the one end to a modified 6th grade work at the other. Much attention is also given 
to physical training, woodworking, music and domestic science by teachers especially 
trained for these subjects. 

The real hope of the defective child is to be placed in the training which he receives 
in the use of his hands because it is only by his hands that he is ever going to be useful 
either in the community or in the institution. This important phase of our educational 
system has been fully recognized and has been met during the year in a most practical 
manner by the opening of the two new industrial buildings, one for each sex. The 
realization of these buildings has made it possible to gather up the various industrial 
activities which were scattered over the institution in improvised quarters and house 
them in appropriate buildings and thereby give this important part of our educational 
curriculum the proper supervision. The improvement in this department is already 
noticeable. 

Another important event in the development of the institution took place during 
the year in the addition to the plant of the new Assembly Hall. This building com- 
prises an attractive auditorium of 1,100 seats, a large, well equipped stage with con- 
venient dressing rooms, a first class moving picture machine with booth and curtain. 



P.D. 117. 



67 



In the light, airy basement are accommodated well furnished, attractive club rooms 
for the employees, consisting of a general lounge, ladies' room, pool room, 2 bowling 
alleys, smoking room, a store and a refreshment room. This building furnishes a social 
center for the whole institution, — children and employees ahke, with the consequent 
social betterment and increased happiness for all. 

The farm continues to be the most valuable school activity for our boys, not only 
in the useful knowledge there obtained but also in the quantities of fresh produce of 
real value furnished by the farm. 

The removal of the few adult male defective delinquents from the school has been 
followed by improvement in morale, happiness and general well-being in the boys' 
departments quite out of proportion to the number removed from the school. The 
adult women of this class however, as well as those under seventeen years of age of 
both sexes, still constitute a great menace to the institution. The presence in the 
institution of the comparatively small number of this class provides a constant factor 
opposed to the advancement and happiness of the large numbers of the feeble-minded 
for whom the institution was created. 

Through the conscientious, skillful efforts of our social service workers, commendable 
progress has been made in the adjustment in the community of carefully selected boys 
and girls who have been trained in the institution. 

The regular clinics at the institution and the established school clinics in the various 
cities and towns are proving to be convenient avenues through which the specialized 
resources of the institution are easily made available to the community. 

The recognition by the authorities of a wage scale for ward service that approximates 
a commensurate amount and which was made operative in July is especially noteworthy 
inasmuch as it has resulted for the first time in this institution in securing a suitable 
number of employees for this important branch of the service. 

Belchertown State School. 

Opened in November, 1922. Present capacity, 710. 
Daily average number of patients, 328. 
Number Oct. 1, 1923, 428. 

Finances. 

Expenditures from maintenance funds, $226,627; total receipts, $1,141, being 
$500 from private patients, $42 from reimbursing patients, $599 from other sources. 

Weekly per capita cost of maintenance computed on net expenses, $13.25. 

Weekly per capita cost of whole service, $5.35; ward service, $1.41. 

One person employed for every 3.79 patients; 1 nurse for every 9.78 patients. 

Average monthly wage for all persons employed $87.98; for nurses, $60.05; 
male ward service, $58.01; female ward service, $64.86. 

The general statistics for the year are as follows: 





Males. 


Females. 


Totals. 


Number present Sept. 30, 1922 








Received during year 


266 


219 


485 


Total on books during year 


266 


219 


485 


Discharged to community 


4 




4 




6 


1 


7 


Died 


7 


3 


10 




17 


4 


21 


Number present Sept. 30. 1923 


249 


215 


264 



Extract from Trustees' Annual Report. 

The board has been cognizant of the difficulties attendant upon the opening of a 
new institution, and each month throughout the year has noted with satisfaction in- 
creased facilities for the care of the patients, the purchase of play materials for the 
younger children in the wards, play-ground equipment, the inauguration of physical 



68 P.D. 117. 

training activities, out-of-door sports, and indoor festivities, all of which have militated 
for happiness. 

The gradual development of hand-work for the girls and industrial work for the 
boys, in cramped and inadequate quarters, is suggestive of future development under 
more auspicious conditions. The same is true of the school department. 

The out-of-door activities in digging and grading and the farm work of the able 
bodied boys, have given wholesome, purposeful occupation, which reacts in cheerful- 
ness and self respect among the workers. 

We have seen the salutary effect of the removal of the defective delinquent group 
of boys between the ages of 17 and 25 to the newly opened department at the Bridge- 
water State Hospital, provided for the needs of this group, and would give heartiest 
endorsement of the movement to extend this provision to juvenile delinquent boys 
under 17 years of age. We also recognize urgent need of similar provision for the 
younger and older groups of defective delinquent girls. 

During the year the board has given serious consideration to the many requests of 
parents and others for the discharge of patients. In this connection the assistance to 
intelligent and wise decisions which has been rendered by the social service depart- 
ment cannot be over-stated. 

We have favored wherever possible, feasible and safe, the return to the community 
of those individuals who can be adequately protected, and of those who, under the 
same conditions, can contribute to their own support. The recent provision for parole 
has already proven its value. 

As we look forward to another year of service we earnestly hope that the plans for 
the rapid and orderly development of the institution may proceed without interruption. 

Extract from Superintendent's Annual Report. 

Social Service. — This department has been established and has found abundant in- 
vestigating, both in the interests of our resident population and in maintaining super- 
vision of children on parole. In addition, this department has investigated the status 
of a waiting list compiled from Waverley and Wrentham unsatisfied applications. 

Employed. — During the year, 2 boys and 1 girl have been paroled to go to work. 
One boy is with relatives and is earning a small sum weekly, the other is earning S5.00 
per week and maintenance and the girl is earning $9.00 per week in a laundry. The 
benefits of the 1922 parole law are clearly manifest in the disposition of this group of 
cases. 

Defective Delinquents. — The defective delinquent of 16 years or over, heretofore a 
great menace to the welfare of the School, can be sent to a special department but 
there is still left the delinquent of less than 16 years who is a problem no less trouble- 
some. It is believed that provision should be made to relieve the schools for the feeble- 
minded from this younger set of boys and the defective delinquent girls. 

Clinics. — Wednesday of each week has been set aside for the examination of children 
who may be brought to the School. Social agencies have been notified of this reserva- 
tion of Wednesday. 

Progress of Building. — During this year new buildmgs have been opened as fol- 
lows; — Custodial Building for 145 girls; Dormitory for 105 girls; Employees' Cottages 
No. 3 and No. 7. The Laundry Building has been occupied as a laundry, besides giving 
space for 4 school-rooms and temporary Assembly Hall. Six new buildings have been 
begun during the year. Four sewer beds have been finished and put into operation. 
The water system has been extended, increasing supply and protection. 

Hospital Cottages for Children. 

Opened in June, 1882. This is a private institution for which the Governor 
appoints five Trustees in addition to those selected by the Corporation. It is 
maintained from the income of private funds, donations and the board of patients. 
State and town charges are received for $5.50 a week, although the weekly cost 
of support is considerably in excess of this amount. 

The general statistics for the year are as follows: 



Patients in the hospital October 1, 1922 .92 

Admitted within the year 47 

Whole number of cases within the year 139 

Dismissed within the year ......... 44 

Number remaining, September 30, 1923 95 

The largest number on any day ........ 99 

The smallest number on any day ........ 87 

The average for the year .......... 94 



P.D. 117. 69 

Extract from Superintendent's Annual Report. 
The classes of cases cared for at this hospital are : — 

First — Children suffering from nervous disorders, not feeble-minded. A child 
needing hospital care and treatment is not excluded because of mental defect, especially 
if too young to be admitted to the state schools for the feeble-minded. 

Second — Epileptic children under ten years of age. For exceptional reasons older 
epileptic children are sometimes admitted, but rarely those over 14 years of age. 

Third — Children with paralyses, deformities, disease of the spine, hip, knee and 
other joints, and other affections likely to require long residence in a hospital. Many 
cases may be greatly benefited by graded muscular exercises and massage which can 
best be carried out under institutional supervision. 

Fourth — Children needing operation or fitting of supports. These return to their 
homes as soon as the appliances are well fitted, usually in a few days, and may be 
brought to the hospital at short intervals for observation. 

Vicious children, or those with contagious diseases, are not received. 

Children are supported in the following ways: 

First — There are a few free beds, but not nearly enough for all who apply for them. 
Those who maintain them may nominate suitable children to occupy them. 

Second — In consideration of the assistance this institution received in its earlier 
years from public funds in the erection of buildings and structural improvements, a 
special charity rate, much below cost, has been made for the board and care of suitable 
children dependent for support upon the State or any city or town within the Com- 
monwealth. 

Third — Those who are able are expected to pay at least the average cost, which is 
about S9 per week. Those outside Massachusetts are expected to pay the average 
cost. If a private nurse or extraordinary attention is required, the charge is graded to 
fit the conditions. The income from invested funds and the contributions of charitable 
people make it possible to offer rates below cost, down to $6 per week, in cases unable 
to pay more. Occasionally children are supported by some society or organization in 
their own community. In all cases under this third head, a written agreement for 
support is required. 

No other legal papers or proceedings are required. Children are not "committed" 
to this institution or "adopted" by it. They are admitted upon the voluntary appli- 
cation of those who are responsible for their care and support. Parents or natural or 
legal guardians do not relinquish their rights in them or responsibility for them further 
than their care, treatment and training for the time being. Any suitable case may be 
received without formality if there is a bed available and the support has been pro- 
vided for in one of the above ways. AppUcation blanks and further information will 
be furnished upon request addressed to the Superintendent. 



THE PRIVATE INSTITUTIONS. 
The McLean Hospital. 
Opened in October, 1818. Present capacity, 220. 

Daily average number of patients on books, 211; in hospital, 207; on visit or 
escape, 4. 

Number on books Oct. 1, 192.3, 221; in hospital, 214; on visit or escape, 7. 
All admissions, 94. 

Admissions as insane, exclusive of temporarj^-care cases, 84. 
First cases of insanity, 50. 
Voluntary admissions, 15. 
Temporary-care admissions, 31. 

Extract from Superintendent's Annual Report. 

It will be noted that the percentage of voluntary patients remaining in the Hospital 
at the end of the year was only 6.57 per cent as compared with 34.1 per cent at the 
end of the year 1922. The average has been from 30 to 40 per cent for some years. 

This change, which I believe to be unfortunate, was brought about by a ruling of one 
of the Justices of the Supreme Court of Massachusetts during a hearing on a writ of 
habeas corpus. 

The patient had been admitted to the Hospital on a voluntary basis, desiring to be 
so admitted and fully understanding the nature of her act when signing the voluntary 
apphcation for admission, and at the time of the habeas corpus proceedings the patient's 



70 P.D. 117. 

mental condition was such that she said she understood her status at the Hospital to 
be that of a vohuitary patient and that she wished to remain in the Hospital until 
she was better. (Application for the writ of habeas corpus was made at the instigation 
of a relative who was not in sympathy with the patient's guardian.) She was never- 
theless obviously insane, as was testified to during the court proceedings by the Hospital 
Superintendent and by outside Alienists. At the close of the hearing the Judge found 
the patient insane and a proper case for hospital care, but ruled that as she was insane 
she should be committed as insane and that he could not consider her ''mentally compe- 
tent" and so able to remain at the Hospital voluntarily. His ruling amounted to 
saying that an insane person could not be ''mentally competent" to apply for voluntary 
treatment, as insanity was inconsistent with the mental competence required by the 
voluntary admission law. 

The law^ under which voluntary patients had been admitted for many years and up 
to January, 1921, read: "... who is desirous of submitting himself to treatment 
and who makes wTitten application therefor and whose mental condition is such as to 
render him competent to make the application ..." Whereas the law as it is at 
present and has been since January, 1921, reads: "... who is desirous of submitting 
himself to treatment and who being mentally competent makes written application 
therefor ..." 

I know of no reason to believe that the change in the wording of the law was made 
with any intention of changing the meaning of the law. It seems probable that this 
change was made only to condense and shorten the section. Nevertheless, the inter- 
pretation by the court of "mentally competent" as meaning mentally competent in 
its general sense, rather than mentally competent to make the application, virtually 
declared that no patient could be admitted as a voluntary patient to a hospital for 
mental diseases in Massachusetts who could be committed as insane, and the State 
Department of Mental Diseases in its "Regulations Relating to Voluntary Patients," 
adopted February 5, 1923, practically so interpreted the court's decision. 

An act making possible the voluntary admission to mental hospitals of certain persons 
mentally ill was first adopted by the Commonwealth of Massachusetts in 1881. It was 
distinctly a forward movement and its increased use in this State and its adoption by 
many other states indicate its need and usefulness. By reason of it many patients 
have sought treatment in mental hospitals early in the course of their mental illness, 
when favorable response to treatment is most likely to result, patients who otherwise 
would have postponed the desirable treatment had they been obliged to accept a foiTnal 
commitment as insane by a judge in order to make such treatment available. 

There are many patients who could be pronounced insane who nevertheless realize 
clearly their condition and who desire hospital treatment and who should be allowed 
the privilege of such treatment without having put upon them the stigma, as it is con- 
sidered by many, of being adjudged insane. The law as it read previous to January, 
1921, allowed such patients this privilege, and many who took advantage of it and 
were restored to health and usefulness again in the world were appreciative of the 
opportunity to have had their mental illnesses dealt with on much the same ground 
as are those of a physical nature. 

The sooner the public can be educated to an attitude toward mental diseases similar 
to its attitude toward physical diseases the sooner will the deserved confidence in 
mental hospitals be established. Such confidence must be developed in order that 
those mentally ill may seek early in the course of their illness the treatment needed at 
a time when results are most favorable. The free and easy admission of voluntary 
patients has done much to educate patients and their friends regarding mental illnesses 
and to aboHsh from the public mind the idea that there is a stigma connected with 
mental diseases. 

It is extremely desirable that the wording of the law regarding the admission of 
voluntary patients, as it now stands, should be altered so as to make possible an inter- 
pretation of it as liberal as it was previous to January 1, 1921, or more so. The public 
welfare demands this. 

Other Private Ijcensed Institutions 

number 21. On September 30, 1923, there were under care of these institutions 
203 patients; the insane numbered 133. There were 228 admissions of the insane 
and 249 dismissals during the year. 

The numbers on September 30, 1923, are set forth in the following tabulation: — 



e, < 
SO 



•sib:)ox 



•S8IBXn8j[ 



o 
> 



•SIt3?OX 



I lO C30 05 ^ I I 



(M OS ^ Tt» irs ^ 



05 05 OO l« 



to 



. .8 



o 



^"2 



•Q 



-a o c 



3 ii CO o M 



I tH a o 

1^ b£ — ' 



Q c 



CUE 



u.:: c-^ 



c 

Hi! 



72 



P.D. 117 



FAMILY CARE OF THE INSANE. 
Under Department of Mental Diseases. 

First patients boarded in a family Aug. 10, 1885. Since placed, 1,279 different 
patients. 

Number in families Oct. 1, 1923, 27 women. 

There was one admission within the year, an increase of one. 

Daily average number for the year, 27, a decrease of 2. 

Number of families having patients, 15, no increase or decrease, — 5 families 
ha\ing 1 patient; 8 families, 2; 2 famihes, 3. 

Number of cities and towns in which patients are boarded, 5, no increase or 
decrease. 

The general statistics for the year are as follows: — 







1O09 




Increases for 








THE Year. 












i 






i 


% 




i 


















I 


Remaining Sept. 30. 1922 




29 


29 




21 


21 


Admitted within the year ...... 




1 


1 








Viz.: By transfer from institution .... 




1 


1 




1 




Whole number of cases within the year 




30 


30 




\ I 


1 1 


Dismissed within the year 




3 


3 








Viz.: Transferred to institutions .... 




2 


2 




1 




Visit 




1 






1 




Ill 










1» 


2 t 


Remaining Sept. 30, 1923 




27 


27 




21 


21 


Viz.: Supported by State 




25 


25 




21 


21 


Private 














Reimbursing 














Self-supporting 




2 


2 








Number of different persons within the year 




30 


30 




11 


11 


Number of different persons admitted .... 




1 


1 




1 


1 


Number of different persons dismissed 




3 


3 




1 




Daily average number 




27.93 


27.93 




2.301 


2.301 


Viz.; State 




26.71 


26.71 




1.94» 


1.941 


Reimbursing 














Private 














Self-supporting 




1.22 


1.22 




.361 


.361 



1 Decrease. 



The total weekly per capita expenditure of the State on account of patients in 
private families for the year ending Nov. 30, 1923, and since Oct. 1, 1889, are 
shown as follows: — 





Fiscal Year 

ending 
Nov. 30, 1923. 


Since 
Oct. 1, 1889. 


Payments for board 


$5,241 05 


$722,165 18 


Average number of patients, exclusive of private patients 


27.46 


161.87 


Weekly per capita cost of board 


3 67 


2 66 




66 03 


2,849 64 


Payments for medical attendance, etc., not included in board rate 


6 00 


4,757 64 


Weekly per capita cost of such expenses, outside of board rate . 


05 


02 


Weekly per capita cost of support (being cost of board, clothing, medical 


3 72 




attendance, etc.) ........... 


2 68 


PaymentH for supervision (being transportation, salaries and expenses of 




100,252 58 




2,156 56 




27.46 


167.34 


Weekly per capita cost of supervision 


1 51 


46 


Weekly per capita cost of support and supervision 


5 23 


3 15 



P.D. 117. 



Under Trustees. 



73 



The trustees of institutions were authorized, by Chapter 458 of the Acts of 
1905, to place their patients in the care of private famihes under substantially 
the same conditions as the Department of Mental Diseases. 

First patient boarded June 13, 1905. Since placed, 1,067 different patients. 

Number in families Oct. 1, 1923, 141 — 9 men and 132 women. 

Placed during the year 75 persons, a decrease of 34. 

Daily average number for year, 151. 

Number of families having patients, 88, a decrease of 15, — 64 families having 
1 patient each; 7 families, 2; 6 families, 3; 10 families, 4; 1 family, 5. 

Number of towns in which patients are boarded, 54, a decrease of 11. Largest 
number of patients in any one town, 12; of families, 5. 

The general statistics for the year are as follows: — 



74 



P.D. 117. 




rj-j 

III 



£3 

«^ a G 





.S 

!C CO • • 

•• !■■ 1 

'^■a) _<-aj aj-o ■ ■ a .-aj a)-a> c'l' 

gaS ^flS SfcS flS .tjflS ^aB -ScS 

^^is: -gs^ ss^ -gs^ -oS^ -^^^ i::^^ 

^ .22 .2 .2 fl a S 
s£Q«QQOOW 



P.D. 117. 



75 



I O 00 lO 05 CO 
) lO PO CO 

1 05 «o -^cs-^ 



)eO»-H ic CO ^ »-( ^ eo e<) CM o 



CO >0 .-I 
lOO CO 



CO lO 




76 



P.D. 117. 



THE DEPARTMENT. 

PROCEEDINGS. 

Twelve meetings of the Commissioners were held during the year. 

Fifty-six visits of inspection were made by the Commissioners and Assistant 
Commissioner, in addition to five hundred and twenty-eight visits by the Patholo- 
gist, Assistants to the Commissioner, Director of Social Service, Financial Agent, 
Engineer, Farm Supervisor, etc. 

Ninety-two visits relative to Support matters were made to the institutions by 
agents of the Support Department. 

ESTIMATES OF STATE EXPENSES FOR 1924 

as approved on account of the mentally sick, the feeble-minded and epileptic, are 
listed below, excluding estimates for the maintenance of the State Infirmary and 
Bridgewater State Hospital, whose estimates are inseparable from those of the 
institutions as a whole, the State Infirmary being supervised by the Department 
of Public Welfare, and the Bridgewater State Hospital by the Department of 
Correction. 

These estimates comprise estimates by the Department of Mental Diseases and 
by the State institutions. 

Estimates for the State Institutions 

relate (1) to maintenance expenses, inclusive of repairs and renewals, and (2) 
special expenses for new buildings, additions, new furnishings and equipment in 
the main. 

Estimates for Maintenance Expenses 

as requested by the trustees of institutions, and the amounts as recommended by 
the department, appear in the following tabulation: — 





Institutions' 


Recommended 




Estimates. 


by Department. 


Boston Psychopathic Hospital 


$252,061 91 


$238,849 49 


Boston Hospital 


881,761 73 


839,363 76 




662,338 14 


640,140 69 


Foxborough Hospital 


359,692 76 


353,372 75 




411,473 39 


378,205 43 


Grafton Hospital 


588,044 71 


578,575 23 


Medfield Hospital 


676,466 46 


663,600 30 




414,985 78 


406,536 50 




652,566 94 


592,711 60 


Westborough Hospital 


608,781 13 


587,129 18 


Worcester Hospital 


869,489 94 


827,720 24 




466,020 58 


451,299 84 




315,843 85 


298,996 31 


School for the Feeble-Minded at Waltham 


641,294 19 


623,827 73 




521,905 46 


501,764 62 




$8,322,726 97 


$7,982,083 67 



Estimates for Special Appropriations 

for the State institutions under the Department have been prepared and are 
classified below: 

Boston State Hospital: 

1. Constructing and furnishing Administration Build- 

ing and Staff Quarters $180,000 00 

2. Extension to Sewer, Water and Steam Lines . . 13,000 00 

3. Purchase of Land 30,000 00 

4. Concrete Pavement in Front of Power House . . 10,000 00 

5. Concrete Platform for Coal Storage 6,000 00 
G. Constructing and furnishing Cottage for Farm Em- 
ployees 34,000 00 

$273,000 00 



P.D. 117. 

Danvers State Hospital : 

1. Food Service Equipment . . . . . 

Foxborough State Hospital: 

1. Addition and Alterations to Ward 12 Buildings and 
Construction of Connecting Corridor . 

Gardner State Colony: 

1. Additional Water Supply 

2. Garage and Fire Station 

3. Dairy Farm ..... 

4. Building on top of Root Cellar, Main Group 

5. Ice House-Hillcrest .... 

6. Addition to Fairview Cottage 

7. Repairs on Coal Trestle 

Grafton State Hospital: 

1. Constructing Chapel and Assembly Hall 

2, Kitchen Addition to Pines Service Building . 

Medfield State Hospital: 

1. Furnishing Two Officers' Cottages 

Northampton State Hospital: 

1. Constructing and furnishing Ward Building for 84 

patients ........ 

2. Additional Appropriation for Ward Building au- 

thorized in 1923 

3. Sewer Connections 

4. Pavilion .... 

5. Sprinkler System 

6. Standpipe for Fire Protection 

Westborough State Hospital: 

1 . Renovation of Wards A, B and C in Cottage 

2. New Porch, West Wing .... 

Worcester State Hospital : 

1. Congregate Dining-Room .... 

Monson State Hospital: 

1. Addition to Administration Building 

Belchertown State School : 

1. Constructing and furnishing Administration Build 

ing 

2. Constructing Garage ..... 

3. Constructing and furnishing two Dormitories each 

for 105 Boys . 

4. Constructing and furnishing Employees' Cottages 

(4 and 9) 

5. Extension of Water and Sewerage System 

6. Drainage, Grading, Walks and Roads . 

7. Piggery 

8. Root Cellar and Apple House 

9. Furnishings and Equipment 
Carpenter and Machine Shop 

Second Story over Pipe Shop for Storage of Elec 
trical Supplies ..... 
12. Painting Interiors of Certain Wards and Cottages 
Install Dampers in Heating Stacks 



10. 
11. 



13. 



Massachusetts School for Feeble-Minded : 

1. Laundry . . 

2. Electric Lighting and Equipment (Templeton 

Colony) ........ 

3. Nurses' Home Extension ..... 

4. Side Track-Bill of Boston & Maine Railroad . 

Wrentham State School: 

1. Constructing and furnishing two Cottages for 21 

Employees each ...... 

2. Constructing Cottage for Married Employee . 

3. Tool House 

4. Equipment for Athletic Field .... 

5. Sprinkler System for Two Industrial Buildings 



$35,000 00 
10,000 00 
17,000 00 
3,000 00 
900 00 
9,000 00 
8,600 00 



$55,000 00 
15,000 00 



$140,500 00 

40,500 00 
600 00 
8,000 00 
9,175 00 
2,757 00 



$7,000 00 
7,000 00 



$65,000 00 
7,500 00 

200,000 00 

55,000 00 
40,000 00 
40,000 00 
3,500 00 
7,000 00 
31,355 00 
10,000 00 

935 00 
300 00 
2,800 00 



$25,000 00 

15,000 00 
5,900 00 
626 25 



$60,000 00 
5,000 00 
1,500 00 
2,500 00 
1,930 00 



77 

$7,300 00 
200.000 00 



83,500 00 

70,000 00 
5,500 00 



201,532 00 

14,000 00 
150,000 00 

35,000 00 



463,390 00 



46,526 25 



f0,930 00 



Total 



$1,620,678 25 



78 



Estimates by the Department. 



1. Personal Services ...... 

2. Office Supplies and Equipment 

3. Traveling and Other Expenses 

4. Transportation and Medical Examination 

5. Support of Insane Paupers Boarded in Families 

6. Support of State Paupers in Hospital Cottages for Children 

7. Investigation of Mental Diseases and Defects; Special Projects of Mental 

Hygiene Division; Routine work of Psychiatric Institute 



FINANCIAL STATEMENTS. 

Statement of Appropriations made to the Department for the Fiscal 
Year ending November 30, 1923. 





Appropria- 
tions. 


Amount 
expended. 


Balance. 


For personal services 

For other services, including printing the annual report, travel- 
ing and office supplies and equipment ..... 

For transportation and medical examination of state paupers . 

For the support of insane paupers boarded in families 

For the support of State paupers in the Hospital Cottages for 
Children ........... 

For an investigation as to the nature, causes, results and treat- 
ment of mental diseases and defects and the publication of the 


$88,660 001 

22,374 552 
15,196 083 
6,512 864 

15,500 00 
25,006 005 


$84,252 76 

17,256 34 
7,821 13 
5,313 08 

12,080 51 
6,896 92 


$4,407 24 

5,118 21 
7,374 95 
1,199 78 

3,419 49 
18,109 08 


$173,249 49 


$133,620 74 


$39,628 75 



1 Credit to our appropriation, $660.00. 

2 Brought forward from balance of 1922 appropriation, $788.24; refunds, $1,186.31; making a total of 
$1,974.55. 

s Refunds, $196.08. 

* Brought forward from balance of 1922 appropriation, $12.86. 
5 Refund, $6.00. 



Statement of Receipts and Disbursements of the Department for the 
Year ending November 30, 1923. 

Receipts. 

Payable to State Treasurer: — 

For support of patients in family care .... 

For support of patients in Hospital Cottages for Children 
Refunds ......... 

Licenses ......... 

Use of Land, Metropolitan Site ..... 

Interest ......... 



Total payable to State Treasurer 

Payable to State Institutions: — 
For support of patients in — 
Boston Psychopathic Hospital 
Boston State Hospital 
Danvers State Hospital 
Foxborough State Hospital . 
Gardner State Colony 
Grafton State Hospital 
Medfield State Hospital 
Northampton State Hospital 
Taunton State Hospital 
Westborough State Hospital 
Worcester State Hospital 
Monson State Ho.spital 
Belchertown State School ... 
Massachusetts School for the Feeble-Minded 
Wrentham State School 
State Infirmary ..... 
State Farm ..... 

Total payable to State Institutions . 

Total receipts .... 



$91 


15 


2,351 


69 


1,150 00 


10 


00 


105 


41 


$3,708 


25 


$3,246 


00 


52,156 


29 


37,898 


60 


9,170 


76 


2,753 


55 


4,473 


21 


17,138 


56 


14,010 


09 


24,054 


89 


16,317 


45 


31,037 


80 


2,445 


33 


42 


43 


2,257 


55 


838 


71 


1,719 


08 


5,433 


07 


$224,993 37 


$228,701 


62 



P.D. 117. 79 

Disbursements. 

Paid State Treasurer $3,708 25 

Paid State institutions 224,993 37 

Total disbursements . $228,701 62 



Family Care of the Insane. 

Under Chapter 123, Section 16, of the General Laws, the Department is author- 
ized to place in private families certain suitable inmates of the institutions under 
supervision. For a full report of this work as conducted by the Department and 
by the trustees of certain institutions, see page 72. 

THE SUPPORT DIVISION. 

The function of this Division is to ascertain whether the patients committed 
to the various State Hospitals for the mentally ill, and also the Institutions for 
the Epileptic and Feeble-minded, as public charges, have a legal right to remain 
in said Institutions. If they are aliens and have no such right, having landed in 
the United States within five years of their commitment, investigation is made 
as to their liability to deportation under the United States Immigration Laws, 
and the result of such investigation is reported to the Department. If in the 
United States more than five years, and in Massachusetts less than five years, 
such aliens are reported for deportation by this Department. The Department 
may also remove any pauper inmates of Institutions under its supervision, who 
are not subject to the orders of a court to any country, state or place where they 
belong. If native born, and having no claim on this Commonwealth for support, 
investigation is made to determine upon what State, if any, they have a claim, 
and when so determined, this also is reported to the Department for action. 

The financial condition of those entitled to remain is investigated, and if there 
are means legall}^ available and sufficient to warrant it, the patient is reported 
to the Hospital to be supported privately at a rate to be determined by the Hos- 
pital authorities. If the means are not sufficient for that purpose, a reimbursing 
rate may be made by this Division and submitted to the Department for approval. 

By agreement, Institutions under this Department care for war risk bene- 
ficiaries under commitment, being reimbursed for the same. This has markedly 
increased the work. 

The following is the report of the work of this Division, for the 3^ear ending 
November 30, 1923: 



Visits to the hospitals .......... 93 

Histories taken at the hospitals ......... 2,974 

Visits to relatives of patients and others for investigation .2,112 
Cases submitted for deportation to the U. S. Commissioner of Immigration . 108 
Cases submitted for deportation by the Department ..... 148 



Support Cases, not including Ex-Service Men of the World War. 

Cases pending November 30, 1922 ........ 247 

New cases . . . . . . . . . .1,115 

1,362 

Made private ............ 136 

Made reimbursing ........... 474 

Accepted as State charges .......... 494 

Pending November 30, 1923 258 

1,362 

Private Cases. 



Cases pending Nov. 30, 1922 13 

New cases reported to hospitals . . . . . . . . .151 

164 

Reported by hospitals as having been made private ..... 136 

Made reimbursing ........... 7 

Dropped — accepted as State charges ....... 3 

Pending November 30, 1923 18 

164 



80 



P.D. 117. 



Reimbursing Cases 

Cases remaining November 30, 1922 in hospitals 
New cases ...... 



Made private of the above 

Died 

Discharged or on visit Nov. 30, 1923 
Dropped — accepted as State charges 
Transferred to other institutions 
Remaining iu hospitals Nov. 30, 1923 



983 
481 



7 

160 
159 
93 
20 
1,025 



1,464 



1,464 



Cases of Ex-Service Men of the World War considered by the U. S. Veterans' Bureau for 
Support between November 30, 1922 and November 30, 1923. 



Cases remaining Nov. 30, 1922 in hospitals 
New cases (American 470; Canadian 7) 



Died . . . 

Discharged or on visit 

Transferred to other institutions 

Rejected ..... 

Made private . . 

Remaining in hospitals Nov. 30, 1923 



Ex-service men actually in the hospitals November 30, 

Cases chargeable to Veterans' Bureau 

Cases not yet chargeable (rejected or pending) 



194 
477 



1923 



6 
177 
60 
205 

223 



223 
209 



671 



671 
432 



432 



P.D. 117. 



81 



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82 



Receipts for Support of Reimbursing Patients. 



P.D. 117. 



Location of Patients. 


Year ending 
Nov. 30, 1922. 


Year ending 
Nov. 30, 1923. 


Total since 
Jan. 1, 1904. 


Worcester Hospital 


S46,075 97 


$47,184 02 


$460,014 27 




30,495 56 


35,676 76 


330,834 20 


Northampton Hospital 


33,763 47 


27,398 27 


345,443 10 


63,083 50 


67,431 09 


575,789 58 


West Vioroush Hospital 


32,355 48 


35,162 07 


367,550 24 




49,628 09 


72,232 29 


404,519 66 


Psvohopathic Hospital 


4,957 00 


3,246 00 


8,325 00 


Grafton Hospital 


15,827 42 


10,404 13 


176,875 31 


Medfield Hospital 


28,765 57 


24,896 68 


231 ,090 50 




12,259 65 


12,178 26 


68,931 51 


Gardner State Colony 


3,902 25 


5,013 65 


37,721 55 


Mental Wards, State Infirmary 


6.725 73 


1,719 08 


29,104 81 




6,560 78 


5,433 07 


32,273 24 


^loiison liospittil 


8 968 37 


7 979 72 


88 572 69 


School for Feeble-minded at Waltham .... 


9^226 09 


6!bl5 42 


481644 12 


Wrentham School 


5,970 08 


2,038 66 


17,124 20 






42 43 


42 43 




17 43 


91 15 


891 22 




1,000 00 




15,058 99 








3,370 45 


Almshouses 






923 66 




$359,582 44 


$364,142 75 


$3,249,100 73 



DEPORTATIONS. 

There were considered for deportation 569 cases, compared with 616 for the 
previous year. This Department deported 80 to other states, 14 to other countries, 
— in all, 94. In addition the United States Immigration Commissioner deported 
52. Altogether, 146 have been deported since December 1, 1922. 

Since October 1, 1898, 3,124 persons have been deported by this Department, 
of whom 106 returned once, 13 twice and 3 three times. Of those returning 4 
are now in the institutions of this state. 

Details of the disposition of cases under consideration for deportation are shown 
in the following table: — 



P.D. 



117. 



83 



Totals. 




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United States 
Commissioner of 
Immigration. 


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Department. 


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Deported 

Viz.: Other States 

Special cases not landed under immigration laws and pending 

Discharged 

Viz.: Care of fi lends 

Died 

Viz.: Private patients 

Rejected by Immigration Commissioner 

Deported through agency of the Department . . . ! 
Dropped from further consideration 

No place to go 

Total cases closed 

Cases pending Nov. 30, 1923 

Viz.: Not in condition to deport \ ' 

Awaiting action 

Delayed because of war conditions .... 

On visit 



84 



P.D. 117. 



THE FINANCIAL DIVISION. 

This Division no longer handles collective bujdng through its Stewards' Asso- 
ciation, this having been taken over by the Purchasing Bureau of the Commis- 
sion on Administration and Finance, which has seen fit in most instances to adopt 
the standards and use the specifications this Department followed in its collective 
buying for a number of years. Monthly meetings of the stewards, however, have 
been continued with further standardizations and construction of specifications 
to meet these standards. Administrative and financial problems that have been 
brought to these meetings by the representatives of the various institutions under 
the Department's supervision were discussed, together with problems which the 
Department itself felt should be brought up at a time when the representatives of 
all institutions were present to express their views. These matters cover a large 
field, such as application of ration allowance, table waste, bread making, discus- 
sion of clothing and other materials manufactured and furnished through the 
Department of Correction, laundry work and equipment, ice harvesting and re- 
frigeration, farm and garden rotation of crops and fertihzation, planting of proper 
acreage to meet the requirements of the institution, grain and hay rations for stock, 
proper sprajdng materials to purchase and their apphcation, more efficient and 
labor-saving tools, implements and machines for farm work, best variety of seeds 
for institution needs, standardization of institution printed forms and the starting 
of a Departmental printing plant at the Gardner State Colony. Many problems 
were also brought before the meetings by the Department's engineer and farm 
supervisor. 

Engineering. 

During the year the repairs and maintenance work of the institutions were 
supervised and advice given on various problems. Inspection was constantly 
made of work under construction. Assistance was rendered in developing plans 
for special appropriations. Requests for appropriations were analyzed and recom- 
mendations made. 

Special Appropriations. 

Conditions in the construction field did not change much from those prevailing 
in 1922. Labor and material prices continued on a high level. But few appro- 
priations were allowed by the Legislature and those only for such projects as they 
deemed urgent. The high prices obtained warranted the rejecting of all bids on 
three projects: namely, a ward building at the Northampton State Hospital, an 
extension to the nurses' home at the Massachusetts School for the Feeble-Minded 
and a storehouse addition at the Wrentham State School which were held over 
for lower prices. 

The construction at the power plant at the Danvers State Hospital proceeded 
with the installation of the engines, generators and refrigerating plant machinery; 
the foundations and other preliminary construction work being done by the in- 
stitution forces. The salvage sheds and yard were completed and put to use much 
to the advantage of the hospital. 

The new construction at the Foxborough State Hospital progressed and the 
male infirmary was completed and accepted in the latter part of the year. 

At the Gardner State Colony the hospital building and the laundry were com- 
pleted and put into operation. A serious water shortage threatened due to the 
extended drought in the late summer which severely handicapped the institu- 
tion. The situation was eased, however, by the sinking of additional wells, the 
overhauling of the piping and the installation of a new pump outfit and water 
tank. With the removal of the laundry to the new building the alterations to the 
domestic building made good progress. 

At the Grafton State Hospital one 60-cow unit at the barn was completed and 
another started. The hay barn was completed and the barns occupied permitting 
the tearing down of the old barns. The water supply system connecting with the 
City of Worcester was completed and the water turned on in August, remedying 
a very unsatisfactory water situation at this institution. 



P.D. 117. 



85 



The new kitchen at the Medfield State Hospital was sufficiently completed to 
be put into operation and the work on the congregate dining rooms well advanced. 
They will be completed early in 1924. 

The construction of the heating and power station for the Massachusetts School 
for Feeble-minded at Waverley progressed with the erection of the power house, 
chimney and two boilers. Contracts have been let for the piping and underground 
work. The present engines and generators will be relocated from the present 
power plant and the new plant put into operation during 1924. The institution 
erected one officers' cottage at the Templeton Colony from the standard plans 
and specifications of the Department and is erecting four more at Waverley. 

At the Wrentham State School three additional sewer beds were constructed 
from the plans of the Department's engineer and four more are under construc- 
tion. The assembly hall, boys' industrial building and horse barn were completed 
and the dairy group approached the point of completion. 

There was little new building construction started at the Belchertown State 
School, all efforts being put into completing present contracts and improving the 
grounds. With the acceptance of new buildings and the increasing population, 
the demand on the power house became sufficient to warrant an additional boiler 
and a 300 horse power water tube boiler is being erected. 

Farm. 

Dairy. — The Department has favored the institutions continuing its policy 
of maintaining two herds, one known as the tuberculosis free herd and the other 
known as the Bang herd which is composed entirely of reactors to the tuberculin 
test. The upkeep of the herd was maintained by raising heifer calves and the 
purchase of one carload of cows from accredited herds in Sullivan County, N. H., 
which was shipped to Grafton State Hospital November 29th. 

The following improvements were made last year: 

One hay and storage barn, Belchertown State School. 
One hay barn and cow stable with 60 tie ups, Grafton State Hospital. 
One hay barn and dairy wing made ready for occupancy, Foxborough State 
hospital. 

One hay barn, two dairy wings, and young stock shed made ready for occupancy, 
Wrentham State School. 
Two silos recovered, Northampton State Hospital. 

The keen interest manifested by the institution management for the building 
up of dairy herds has resulted in remarkable gains in milk production and a sub- 
stantial gain in the non tuberculous free herd. 

The average number of cows in 1923 was 39 less than in 1922, but the milk pro- 
duction was increased 529,054.5 qts. or an average of 557.6 qts. per cow. The 
total cows for 1923 was 706.6 and the value of the increase in milk at 10^ per 
quart was $52,905.45. To this should be added the value of the 1923 calf drop. 

The annual meeting of superintendents, stewards, and head farmers was held 
by invitation at the Northampton State Hospital November 21st and 22nd. 
Outside speakers were Prof. J. A. Foord, Massachusetts Agricultural College, Prof. 
J. A. Abbott, Massachusetts Agricultural College, Prof. W. H. Wolfe, Hampden 
County Improvement League, Springfield, Mass., and 0. M. Camburn in charge 
of Dairying Department of Agriculture. An illustrated lecture was given by Mr. 
Hamilton of the De Laval Separator Co. who also exhibited a moving picture 
film of the De Laval Separator Co. mechanical milker. 

During the year there has been installed at all institutions the following forms: — 

1. A standardized form for reporting all farm produce daily. 

2. A standardized form on which to report all produce for the month, one copy 
of which is sent to the Department. 

3. A standardized form for the weekly score card for recording milk production 
of each cow. 



86 P.D. 117. 

Statement of Appropriations for Special Purposes for the Various | 

Institutions. 

Boston Hospital. 

Male Infirmary (Chapter 50, Resolves of 1916; Chapter 629, Acts of 1920; 
Chapter 203, Acts of 1921) : 

Appropriation (1918) $385,000 00 

Appropriation (1920) 16,000 00 

Appropriation (1921) . . , 3,595 80 



Total $404,595 80 

Expenditures previously authorized .... $400,618 60 
Expenditures authorized in 1923 2,296 51 402,915 11 



Balance reverted to State Treasiu-y $1,680 69 

Dining Room, East Group (Chapter 211, Special Acts 1919; Chapter 629, 
Acts 1920) : 

Appropriation (1919) $110,000 00 

Appropriation (1920) 42,000 00 



Total $152,000 00 

Expenditures previously authorized .... $150,579 32 
Expenditures authorized in 1923 - 150,579 32 



Balance available $1,420 68 

Dining Room, West Group (Chapter 211, Special Acts 1919; Chapter 225-629, 
Acts 1920) : 

Appropriation (1919) $100,000 00 

Appropriation (1920) 110,000 00 

Appropriation (1921) 14,100 00 



Total $224,100 00 

Expenditures previously authorized .... $223,086 04 
Expenditures authorized in 1923 897 35 223,983 39 



Balance reverted to State Treasury ....... $116 61 

Home for 90 Nurses (Chapter 211, Special Acts 1919; Chapter 225-629, Acts 
1920; Chapter 203, Acts 1921): 

Appropriation (1919) $80,000 00 

Appropriation (1920) 57,500 00 

Appropriation (1921) 15,200 00 



Total $152,700 00 

Expenditures previously authorized .... $151,230 55 

Expenditures authorized in 1923 1,459 92 

152,690 47 



Balance reverted to State Treasury ....... $9 53 

Laundry Building (Chapter 203, Acts of 1921) : 

Appropriation $15,000 00 

Expenditures previously authorized .... $4,561 98 

Expenditures authorized in 1923 10,365 00 

14,926 98 



Balance reverted to State Treasury ....... $73 02 

Sewer Line (Chapter 203, Acts of 1921) : 

Appropriation $5,000 00 

Expenditures previously authorized .... $4,047 53 

Expenditures authorized in 1923 ..... 242 55 

4,290 08 



Balance reverted to State Treasury $709 92 

Veranda C (Chapter 129, Acts 1922) : 

Appropriation $8,000 00 

Expenditures previously authorized .... $6,754 10 

Expenditures authorized in 1923 1,237 80 

7,991 90 



Balance available .......... $8 10 

Veranda G (Chapter 129, Acts 1922) : 

Appropriation $5,000 00 

Expenditures previously authorized .... $4,109 00 

Expenditures authorized in 1923 ..... 772 07 

4,881 07 



Balance available $118 93 



P.D. 117. 

Addition to Bakery (Chapter 129, Acts 1922) : 

Appropriation ........... 

Expenditures previously authorized .... $31,654 37 

Expenditures authorized in 1923 4,323 18 



Balance available . . . . . . . . . . 

Addition to Refrigerating Room (Chapter 129, Acts 1922) : 

Appropriation ........... 

Expenditures previously authorized .... $6,643 92 

Expenditures authorized in 1923 ..... 15,262 58 



Balance available ..... 

Superintendent's House (Chapter 126, Acts 1923) : 
Appropriation ...... 

Expenditures authorized in 1923 

Balance available ..... 



Danvers Hospital. 

Power Plant (Chapter 629, Acts of 1920) : 

Appropriation ........... 

Expenditures previously authorized .... $211,677 43 

Expenditures authorized in 1923 ..... 25,658 54 



Balance available .......... 

Electrical, Refrigerating and Lighting Plant (Chapter 203, Acts 1921) : 

Appropriation ........... 

Expenditures previously authorized .... $63 60 

Expenditures authorized in 1923 30,954 16 



Balance available .......... 

Salvage Yard Sheds (Chapter 129, Acts 1922) : 

Appropriation ........... 

Expenditures previously authorized .... $1,866 78 

Expenditures authorized in 1923 ..... 877 34 



Balance reverted to State Treasury 
Storage House (Chapter 126, Acts 1923) : 
Appropriation .... 
Expenditiu-es authorized in 1923 

Balance available 



Foxhorough Hospital. 

Sewer Beds (Chapter 124, Resolves 1917; Chapter 129, Acts 1922): 

Appropriation ........... 

Expenditures previously authorized .... $15,007 80 

Expenditures authorized in 1923 . . . . . 40 10 



Balance available .......... 

Male Infirmary (Chapter 203, Acts 1921) : 

Appropriation ........... 

Expenditures previously authorized .... $81,112 23 

Expenditures authorized in 1923 74,640 64 



Balance available .......... 

Renovation of Ward E (Chapter 203, Acts 1921) : 

Appropriation ........... 

Expenditures previously authorized .... $9,044 49 

Expenditures authorized in 1923 2,681 03 



87 

$36,000 00 

35,977 55 

$22 45 
$23,000 00 

21,906 50 

$1,093 50 

$15,000 00 
5,279 47 

$9,720 53 

$250,000 00 

237,335 97 

$12,664 03 
$50,000 00 

31,017 76 

$18,982 24 
$2,750 00 

2,744 12 

$5 88 
$6,000 00 

$6,000 00 

$17,500 00 

15,047 90 
$2,452 10 
$159,000 00 

155,752 87 
$3,247 13 
$12,750 00 

11,725 52 



Balance available 



$1,024 48 



88 P.D. 117. 

Barn (Chapter 203, Acts of 1921) : 

Appropriation S28,000 00 

Expenditures previously authorized .... $20,574 14 

Expenditures authorized in 1923 7,424 63 

27,998 77 



Balance reverted to State Treasury ....... SI 23 

Two Male Wards (Chapter 129, Acts 1922): 

Appropriation $285,000 00 

Expenditures preAdously authorized .... $57,527 42 

Expenditures authorized in 1923 . . . . . 122,874 04 

180,401 46 



Balance available $104,598 54 

Engine Room Equipment (Chapter 129, Acts 1922) : 

Appropriation $24,500 00 

Expenditures previously authorized .... $14,199 26 

Expenditures authorized in 1923 7,319 83 

21,519 09 



Balance available $2,980 91 

Furnishing New Buildings (Chapter 129, Acts 1922) : 

Appropriation $7,500 00 

Expenditures previously authorized . . . . $4,835 77 

Expenditures authorized in 1923 2,654 22 

7,489 99 



Balance available . . . . . . . . . . $10 01 

Administration Building (Chapter 126, Acts 1923) : 

Appropriation $130,000 00 

Expenditures authorized in 1923 ........ 19 60 



Balance available $129,980 40 

Ward Buildings Furnishings (Chapter 126, Acts 1923) : 

Appropriation $20,000 00 

Expenditures authorized in 1923 ........ 15,355 04 



Balance available . $4,644 96 

Purchase of Land (Chapter 126, Acts of 1923) : 

Appropriation $5,000 00 

Expenditures authorized in 1923 ........ - 



Balance available $5,000 00 

Gardner Colony. 

Hospital Building (Chapter 129, Acts 1922) : 

Appropriation $134,000 00 

Expenditures previously authorized .... $69,487 07 

Expenditures authorized in 1923 ..... 62,752 64 

132,239 71 



Balance available $1,760 29 

Water Supply Extension (Chapter 129, Acts 1922; Chapter 546, Acts 1922) : 

Appropriation (1922) $5,000 00 

Appropriation (1922) 15,000 00 



$20,000 00 

Expenditures previously authorized ..... - 

Expenditures authorized in 1923 $14,172 66 

14,172 66 



Balance available $5,827 34 

Laundry (Chapter 129, Acts 1922) : 

Appropriation $23,000 00 

Expenditures previously authorized .... $14,080 26 

Expenditures authorized in 1923 8,666 54 

22,746 80 



Balance available $253 20 

Alterations in Infirmaries (Chapter 126, Acts 1923) : 

Appropriation ........... $6,000 00 

Expenditures authorized in 1923 ........ - 



Balance available $6,000 00 



P.D. 117. 89 

Alterations in Domestic Building (Chapter 126, Acts 1923) : 

Appropriation $47,000 00 

Expenditures authorized in 1923 33,029 82 



Balance available $13,970 18 

Grafton Hospital. 

Additional Water Supply (Chapter 313, Acts of 1917; Chapter 129, Acts of 
1922) : 

Appropriation $105,000 00 

Expenditures previously authorized .... $67,767 30 

Expenditures authorized in 1923 . . . . . 24,463 90 

92,231 20 



Balance available $12,768 80 

Coal Trestle Extension (Chapter 50, Resolves 1918) : 

Appropriation $10,000 00 

Refund (1922) 69 60 



Total $10,069 60 

Expenditures previously authorized .... $9,532 77 

Expenditures authorized in 1923 ..... - 

9,532 77 



Balance reverted to State Treasury ....... $536 83 

Additional Fire Protection CChapter 153, Acts 1919; Chapter 120, Acts 1922): 

Appropriation $6,000 00 

Expenditures previously authorized .... 5,505 06 

Expenditures authorized in 1923 ..... 480 05 

5,985 11 



Balance reverted to State Treasury ....... $14 89 

Cow Barn (Chapter 203, Acts 1921) : 

Appropriation $10,400 00 

Expenditures previously authorized .... $8,004 16 

Expenditures authorized in 1923 2,394 59 

10,398 75 



Balance reverted to State Treasury . . . . . . . $1 25 

Water System (Chapter 129, Acts of 1922) : 

Appropriation $45,000 00 

Expenditures previously authorized .... $31,341 90 

Expenditures authorized in 1923 11,807 00 

43,148 90 



Balance available .......... $1,851 10 

Cottage (Chapter 129, Acts of 1922) : 

Appropriation $5,000 00 

Expenditures previously authorized .... - 

Expenditures authorized in 1923 $1,764 61 

1,764 61 



Balance available $3,235 39 

Certain Barns (Chapter 129, Acts of 1922) : 

Appropriation $15,000 00 

Expenditures previously authorized . . . . $168 00 

Expenditures authorized in 1923 ..... 9,851 66 

10,019 66 



Balance available $4,980 34 

Medfield Hospital. 

Repairing and Enlarging Sewage Filter Beds (Chapter 96, Resolves 1917; 
Chapter 629, Acts 1920) : 

Appropriation (1917) $24,250 00 

Appropriation (1920) 18,000 00 



Total $42,250 00 

Expenditures previously authorized .... $35,536 47 

Expenditures authorized in 1923 2,547 14 

38,083 61 



Balance available 



$4,166 39 



90 

Kitchen and Dining Room (Chapter 129, Acts of 1922) 
Appropriation ..... 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available .... 
Land and Buildings (Chapter 129, Acts of 1922) : 
Appropriation ..... 
Expenditures previously authorized 
Expenditures authorized in 1923 

Hydriatric Room (Chapter 126, Acts of 1923) : 
Appropriation ..... 
Expenditures authorized in 1923 



Balance available .... 
Bathroom Equipment (Chapter 126, Acts of 1923) : 
Appropriation ..... 
Expenditures authorized in 1923 



Balance available .... 
Purchase of Land (Chapter 126, Acts of 1923); 
Appropriation ..... 
Expenditures authorized in 1923 



Balance available . . 
Water Supply (Chapter 126, Acts of 1923) : 
Appropriation .... 
Expenditures authorized in 1923 



Balance available .... 
Installation of Baths (Chapter 126, Acts of 1923) 
Appropriation ..... 
Expenditures authorized in 1923 



$28,962 79 
42,946 13 



$4,200 00 
2,800 00 



Balance available 



P.D. 117. 

$95,000 00 

71,908 92 
$23,091 08 
$7,000 00 

$7,000 00 
$11,900 00 

$11,900 00 

$7,500 00 
437 50 

$7,062 50 

$3,000 00 

$3,000 00 
$4,300 00 

$4,300 00 
$23,000 00 

$23,000 00 



Northampton Hospital. 



Two Ward Buildings (Chapter 126, Acts 1923) : 
Appropriation ..... 
Expenditures authorized in 1923 



Balance available ...... 

Purchase of Courtney Property (Chapter 126, Acts 1923) : 
Appropriation ....... 

Expenditures authorized in 1923 .... 



Balance available 



$100,000 00 
95 50 

$99,904 50 

$4,000 00 

$4,000 00 



Taunton Hospital. 



Mill River Dam (Chapter 129, Acts 1922) : 
Appropriation . . . . 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available . . . . . 
Coal Trestle Extension (Chapter 129, Acts 1922): 
Appropriation . . . . 
Expenditures previously authorized 
Expenditures authorized in 1923 



$169 03 
8,690 60 



$7,156 37 
4,843 16 



$9,000 00 

8,859 63 
$140 37 
$12,000 00 

11.999 53 



Balance reverted to State Treasury 

Westborough Hospital. 

Dining Room (Chapter 129, Acts 1922) : 
Api^ropriation . . . . 
Expenditures previously authorized 
Expenditures authorized in 1923 .... 



$28,171 45 
24,822 57 



$0 47 

$53,000 00 
52,994 02 



Balance reverted to State Treasury 



$5 98 



P.D. 117. 



Worcester Hospital. 



Remodeling Worcester Department Heating System (Chapter 123, Resolves 
1917; Chapter 129, Acts 1922): 
Appropriation ........... 

Expenditures previously authorized .... $88,832 65 

Expenditures authorized in 1923 ..... - 



Balance available ..... 

Alterations in Heating Shaft (Chapter 203, Acts 1921) ; 
Appropriation ...... 

Expenditures previously authorized 
Expenditures authorized in 1923 



Balance reverted to State Treasury 



$3,339 05 
12,534 97 



91 



$89,303 00 

88,832 65 

$470 35 
$16,000 00 

15,874 02 
$125 98 



Monson Hospital. 

Farm Cottage (Chapter 129, Acts 1922) : 

Appropriation $9,000 00 

Expenditures previously authorized .... $5,956 32 

Expenditures authorized in 1923 3,043 12 

8,999 44 

Balance reverted to State Treasury ....... $0 56 

Purchase of Cottage (Chapter 129, Acts 1922) : 

Appropriation $3,000 00 

Expenditures pre\'iously authorized .... $1,822 00 

Expenditures authorized in 1923 ..... 1,044 13 

2,866 13 

Balance available $133 87 

Three Cottages (Chapter 126, Acts of 1923): 

Appropriation $15,000 00 

Expenditures authorized in 1923 ........ 4,814 04 

Balance available $10,185 96 

Ice House (Chapter 126, Acts 1923) : 

Appropriation $2,000 00 

Expenditures authorized in 1923 ........ 586 27 

Balance available $1,413 73 



School for the Feeble-Minded at Waltham. 



Side Track (Chapter 50, Resolves 1918) ; 
Appropriation .... 
Expenditures previously authorized 
Expenditures authorized in 1923 



$22,000 00 



Balance available 
Officers' Cottages (Chapter 203, Acts 1921) : 
Appropriation .... 
Expenditures previously authorized 
Expenditures authorized in 1923 



$2,974 82 
6,140 17 



Balance available ......... 

Heating and Power Station (Chapter 129, Acts 1922; Chapter 126, Acts 1923) 
Appropriation (1922) ......... 

Appropriation (1923) ......... 



Total 

Expenditures previously authorized 
Expenditures authorized in 1923 



$17,716 89 
71,212 38 



$25,000 00 



22,000 00 

$3,000 00 
$16,000 00 



9,114 99 

$6,885 01 

$100,000 00 
85,000 00 

$185,000 00 



88,929 27 



Balance available 



$96,070 73 



92 P.D. 117. 

Employees' Quarters (Chapter 129, Acts 1922; Chapter 126, Acts 1923): 

Appropriation (1922) $27,000 00 

Appropriation (1923) 14,000 00 

Total $41,000 00 

Expenditures previously authorized . . . . $185 70 

Expenditures authorized in 1923 ..... 105 95 

291 65 



Balance available $40,708 35 

Furnishings for Officers' Quarters (Chapter 126, Acts 1923) : 

Appropriation $5,000 00 

Expenditures authorized in 1923 ........ - 



Balance available $5,000 00 

House at Templeton (Chapter 494, Acts of 1923) : 

Appropriation $4,500 00 

Expenditures authorized in 1923 ........ 3,434 52 

Balance available $1,065 48 



Wrentham School. 

Purchase of Land (Chapter 50, Resolves 1918; Chapter 129, Acts 1922) : 
Appropriation 

Expenditures previously authorized .... $1,970 00 

Expenditures authorized in 1923 

Balance available 
Purchase of Land and Building (Chapter 242, Special Acts 1919) : 
Appropriation 

Expenditures previously authorized .... $1,339 96 

Expenditures authorized in 1923 



$2,200 00 

1,970 00 
$230 00 
$8,000 00 

1,339 96 
$6,660 04 
$55,000 00 

54,960 00 

Balance reverted to State Treasury ....... $40 00 

Cold Storage Plant (Chapter 225, Acts 1920; Chapter 629, Acts 1920): 

Appropriation . . . $55,000 00 

Expenditures previously authorized .... $54,352 03 



Balance available 

Industrial Building (Chapter 225, Acts 1920; Chapter 629, Acts 1920) 
Appropriation 

Expenditures previously authorized .... $51,470 33 
Expenditures authorized in 1923 3,489 67 



Expenditures authorized in 1923 ..... 612 00 



54,964 03 



Balance reverted to State Treasury ....... $35 97 

Assembly Hall (Chapter 203, Acts 1921): 

Appropriation $94,000 00 

Expenditures previously authorized .... $74,601 56 



Expenditures authorized in 1923 ..... 19,395 55 



93,997 11 



Balance reverted to State Treasury ....... $2 89 

Barn (Chapter 203, Acts 1921) : 

Appropriation $25,000 00 

Expenditures previously authorized .... $14,521 18 



Expenditures authorized in 1923 10,418 76 



24,939 94 



Balance reverted to State Treasury ....... $60 06 

Sewer Beds (Chapter 129, Acts 1922; Chapter 126, Acts 1923): 

Appropriation (1922) $7,800 00 

Appropriation (1923) 10,000 00 

Total $17,800 00 

Expenditures previously authorized .... $7,799 14 

Expenditures authorized in 1923 ..... 1,101 36 

8,900 50 



Balance available 



$8,899 50 



P.D. 117. 

Boys' Industrial Building (Chapter 129. Acts 1922): 
Appropriation . . . . 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available 
Storehouse (Chapter 126, Acts 1923) : 
Appropriation 

Expenditures authorized in 1923 
Balance available 



$21,835 59 
16,481 50 



93 

$40,000 00 

38,317 09 
$1,682 91 
$35,000 00 

$35,000 00 



Belchertown School. 



Custodial Building (Chapter 203, Acts 1921) 
Appropriation ..... 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available .... 
Dormitory Building (Chapter 203, Acts 1921) 
Appropi iation ..... 
Expendituies previously authorized 
Expenditures authorized in 1923 



Balance available .... 
Employees' Cottages (Chapter 203, Acts 1921) 
Appropriation ..... 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available ..... 

Two Dormitory Buildings (Chapter 129, Acts 1922; 
Appropriation ...... 

Appropriation ...... 



Chapter 



Total .... 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available .... 
Employees' Dormitory (Chapter 129, Acts 1922; 
Appropriation (1922) 
Appropriation (1923) 



$100,270 59 
29,989 17 



$63,138 86 
31,855 67 



$24,005 23 
4,530 53 



546, Acts 1922) : 



$74,351 14 
65,321 51 



Chapter 126, Acts 1923) : 



Total .... 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available 
Seri-ice Building (Chapter 129, Acts 1922) : 
Appropriation .... 
Expenditures pre\'iously authorized 
Expenditures authorized in 1923 



Balance available 
Dairy Barn (Chapter 129, Acts 1922) : 
Appropriation 

Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available 
Superintendent's House (Chapter 120, Acts 
Appropriation .... 
Expenditures previously authorized 
Expenditures authorized in 1923 



Balance available 



1922) ; 



$10,132 95 
22,570 72 



$16,751 86 
15,816 75 



$3,809 48 
17,973 31 



$17 50 
2,775 59 



$133,000 00 

130,259 76 
$2,740 24 
$98,000 00 

94,994 53 
$3,005 47 
$29,400 00 

28,535 76 

$864 24 

1155,000 00 
31,000 00 

$186,000 00 



139,672 65 

$46,327 35 

$30,000 00 
27,500 00 

$57,500 00 



32,703 67 

$24,796 33 

$40,000 00 

32,568 61 

$7,431 39 

$30,000 00 

21,782 79 

$8,217 21 

$15,000 00 

2,793 09 

$12,206 91 



94 P.D. 117. 

Land, Buildings (Chapter 160, Resolves 1916; Chapter 127, Resolves 1917): 

Appropriation $150,000 00 

Expenditures previously authorized .... $148,106 13 

Expenditures authorized in 1923 1,886 76 

149,992 89 



Balance reverted to State Treasury . . . . . . . $7 11 

Water Supply (Chapter 224, Gen. Acts 1918) : 

Appropriation $50,000 00 

Expenditures pre\dously authorized .... $47,960 05 

Expenditures authorized in 1923 1,538 16 

49,498 21 ; 



Balance available $501 79 

Custodial Building (Chapter 211, Special Acts 1919; Chapters 225, 629, Acts 
1920) : 

Appropriation (1919) $84,000 00 

Authorized transfer 11,000 00 

Appropriation (1920) 97,700 00 



Total $192,700 00 

Expenditures previously authorized .... $161,285 00 

Expenditures authorized in 1923 31,094 70 

192,379 70 



Balance available $320 30 

Dormitory for 105 Inmates (Chapter 211, Special Acts 1919; Chapters 225, 629, 
Acts 1920) : 

Appropriation (1919) $23,000 00 

Authorized transfer 50,000 00 

Appropriation (1920) 69,492 00 



Total $142,492 00 

Expenditures previously authorized .... $118,898 90 

Expenditures authorized in 1923 23,446 54 

142,345 44 



Balance available .......... $146 56 

Storehouse and Bakery (Chapter 211, Special Acts 1919): 

Appropriation $60,000 00 

Authorized transfer 20,000 00 



Total $80,000 00 

Expenditures previously authorized .... $66,522 97 

Expenditures authorized in 1923 ..... 13,476 39 

79,999 36 



Balance reverted to State Treasury ....... $0 64 

Laundry Building (Chapter 211, Special Acts 1919): 

Appropriation $13,000 00 

Authorized transfer 20,000 00 



Total $33,000 00 

Expenditures previously authorized .... $26,671 54 

Expenditures authorized in 1923 6,327 05 

32,998 59 



Balance available .......... $1 41 

Power House (Chapter 211, Special Acts 1919): 

Appropriation $108,000 00 

Expenditures previously authorized .... $93,433 81 

Expenditures authorized in 1923 14,498 81 

107,932 62 



Balance available .......... $67 38 

Tunnels and Piping (Chapter 211, Special Acts 1919): 

Appropriation $53,000 00 

Expenditures previously authorized .... $49,852 28 

Expenditures authorized in 1923 ..... 3,144 90 

52,997 18 



Balance available .......... $2 82 

Electric Service Lines (Chapter 126, Acts 1923) : 

Appropriation ........... $6,650 00 

Expenditures authorized in 1923 5,446 25 



Balance available $1,203 95 



P.D. 117. 95 

Remodeling and Furnishing Cottages (Chapter 126, Acts 1923) : 

Appropriation $14,000 00 

Expenditures authorized in 1923 ........ 469 11 



Balance available $13,530 89 

Repairs to Gutters and Pipes (Chapter 494, Acts 1923) : 

Appropriation $2,431 20 

Expenditures authorized in 1923 2,427 20 

Balance reverted to State Treasury ....... $4 00 

Additional Boiler (Chapter 494, Acts 1923) : 

Appropriation $7,800 00 

Authorized transfer from extraordinary expenses ..... 3,700 00 



Total $11,500 00 

Expenditures authoiized in 1923 4,895 90 



Balance available $6,604 10 

Spur Track (Chapter 129, Acts 1922) : 

Appropriation $26,000 00 

Expenditures previously authorized .... $2,221 22 

Expenditures authorized in 1923 15,375 90 

17,597 12 



Balance available ^8,402 88 

Water and Sewerage System (Chapter 129, Acts 1922; Chapter 126, Acts 1923) : 

Appropriation (1922) $65,000 00 

Appropriation (1923) 34,800 00 



Total $99,800 00 

Expenditures previously authorized .... $35,404 85 

Expenditures authorized in 1923 54,823 67 

90,228 52 



Balance available $9,571 48 

Tunnels, Conduits, Roads (Chapter 129. Acts 1922) : 

Appropriation $34,000 00 

Expenditures previously authorized .... $25,796 43 

Expenditures authorized in 1923 ..... 8,124 48 

33,920 91 



Balance available .......... $79 09 

Furnishings and Equipment (Chapter 129, Acts 1922; Chapter 126, Acts 1923) : 

Appropriation (1922) $50,000 00 

Appropriation (1923) 59,800 00 

Total $109,800 00 

Expenditures previously authorized .... $26,574 21 

Expenditures authorized in 1923 48,485 23 

75,059 44 



Balance available $34,740 56 

Purchase of Certain Land (Chapter 129, Acts 1922) : 

Appropriation $10,000 00 

Expenditures previously authorized .... $307 95 

Expenditures authorized in 1923 9,639 13 

9,947 08 



Balance available $52 92 

Service Line, Conduit and Tunnel (Chapter 126, Acts 1923) : 

Appropriation $37,000 00 

Expenditures authorized in 1923 21,636 27 



Balance available $15,363 73 

New Walks (Chapter 494, Acts 1923) : 

Appropriation ........... $5,000 00 

Expenditures authorized in 1923 ........ 688 30 



Balance available . . . . . . . " . . . $4,311 70 

Norfolk Hospital. 

Purchase of Certain Land (Chapter 242, Acts 1919; Chapter 502, Acts 1921) : 

Appropriation (1919) $500 00 

Appropriation (1921) 100 00 



Total $600 00 

Expenditures previously authorized .... - 

Expenditures authorized in 1923 ..... $600 00 

$600 00 



96 P.D. 117. 

GENERAL MATTERS. 

NEW LEGISLATION. 
The following acts were passed by the Legislature of 1923: — 

Chapter 180. 

An Act relative to the Payment of Rental by the Commonwealth to the City 
OF Worcester for the Use of its Sewerage System for the Sewage of the 
Worcester State Hospital. 

Be it enacted, etc., as follows: 

Chapter three hundred and sixty-three of the Special Acts of nineteen hundred and 
sixteen, as amended in section two by section one of chapter one hundred and sixty- 
five of the Special Acts of nineteen hundred and nineteen is hereby further amended 
by striking out said section two and inserting in place thereof the following: — Sec- 
tion 2. The commonwealth shall pay to the city of Worcester as rental for the use of 
its sewerage system for the sewage of the Worcester state hospital the sum of thirty- 
one hundred dollars annually for a period of five years, beginning December first, nine- 
teen hundred and twenty-two. [Approved March 28, 1923. 

Chapter 245. 

An Act relative to Transfers and Removals by the Department of Mental 

Diseases. 

Be it enacted, etc., as follows: 

Section 1. Section twenty of chapter one hundred and twenty-three of the Gen- 
eral Laws, as amended by section two of chapter three hundred and seventeen of the 
acts of nineteen hundred and twenty-one and section four of chapter four hundred and 
ten of the acts of nineteen hundred and twenty-two, is hereby further amended by 
striking out, in the seventh, eighth and ninth lines, the words " , and no person shall 
be so transferred to the Bridgewater state hospital unless he has been a criminal and 
vicious in his life", by striking out the fourth sentence, by striking out, in the nine- 
teenth line, the words "state charge" and inserting in place thereof the word: — in- 
mate, — and by striking out, in the twenty-second and twenty-third hnes, the words 
"state charge or indigent", so as to read as follows: — Section 20. The department, 
subject to the following section, may transfer to and from any institution any inmate 
thereof who, in its opinion, is a proper subject for admission to the institution to which 
he is to be transferred; but no such inmate shall be transferred to be detained as an 
insane person unless he has been duly committed as insane by a judge or court. A 
record of such transfer shall be entered in the registers of the institutions to and from 
which he is transferred. The commitment papers, together with an abstract of his 
hospital case record, shall be transmitted with him to the institution to which he is 
transferred. The department may also remove any inmate in any state hospital to 
any country, state or place where he belongs, and may enter into an agreement with 
the corresponding board or commission of any other state for the transfer of any insane 
person from one state to the other where, after a full investigation of all the facts, he 
may be deemed equitably to belong; but no such person shall be removed outside this 
commonwealth if he is subject to the orders of a court of this commonwealth, except 
that any such person who is subject to such orders may be so removed from Bridge- 
water state hospital at any time when he would have been entitled to parole if he had 
not become insane. In making such transfers and removals the department, so far 
as practicable, shall employ nurses or attendants instead of officers of the law, and 
shall employ female nurses or attendants to accompany female patients. 

Section 2. Section eighteen of chapter one hundred and twenty of the General 
Laws is hereby repealed. [Approved April 9, 1923. 

Chapter 331. 

An Act relative to the Investigation by the Department of Mental Diseases 
of the Mental Condition of Certain Persons held for Trial. 

Be it enacted, etc., as follows: 

Section one hundred A of chapter one hundred and twenty-three of the General 
Laws, inserted by chapter four hundred and fifteen of the acts of nineteen hundred 
and twenty-one, is hereby amended by inserting at the end thereof the following: — 
In the event of failure by the clerk of a district court or the trial justice to give notice 



P.D. 117. 



97 



to the department as aforesaid, the same shall be given by the clerk of the superior 
court after entry of the case in said court. Upon giving the notice required by this 
section the clerk of a court or the trial justice shall so certify on the papers. The 
physician maldng such examination shall, upon certification by the department, receive 
the same fees and traveling expenses as provided in section seventy-three for the exami- 
nation of persons committed to institutions and such fees and expenses shall be paid 
in the same manner as provided in section seventy-four for the payment of commit- 
ment expenses, — so as to read as follows: — Section 100 A. Whenever a person is 
indicted by a grand jury for a capital offense or whenever a person, who is known to 
have been indicted for any other offense more than once or to have been previously 
convicted of a felony, is indicted by a grand jury or bound over for trial in the superior 
court, the clerk of the court in which the indictment is returned, or the clerk of the 
district court or the trial justice, as the case may be, shall give notice to the depart- 
ment of mental diseases, and the department shall cause such person to be examined 
with a view to determine his mental condition and the existence of any mental disease 
or defect which would affect his criminal responsibility. The department shall file a 
report of its investigation with the clerk of the court in which the trial is to be held, 
and the report shall be accessible to the court, the district attorney and to the attorney 
for the accused, and shall be admissible as evidence of the mental condition of the 
accused. In the event of failure by the clerk of a district court or the trial justice to 
give notice to the department as aforesaid, the same shall be given by the clerk of 
the superior court after entry of the case in said court. Upon giving the notice re- 
quired by this section the clerk of a court or the trial justice shall so certify on the 
papers. The physician making such examination shall, upon certification by the de- 
partment, receive the same fees and traveling expenses as provided in section seventy- 
three for the examination of persons committed to institutions and such fees and ex- 
penses shall be paid in the same manner as provided in section seventy-four for the 
payment of commitment expenses. [Approved April 30, 1923. 

Chapter 397. 

An Act relative to Dockets and Records in Defective Delinquent Proceedings. 

Be it enacted, etc., as follows: 

Section one hundred and twenty-one of chapter one hundred and twenty-three of the 
General Laws is hereby amended by striking out all after the word "kept" in the third 
line and inserting in place thereof the following: — by the clerk of the court in which 
the justice making the commitment under said sections sits. The clerk shall receive 
and keep on file the original application, the certificate of physicians and the copy of 
the order of commitment attested by and with the return thereon of the officer or other 
person serving the same, — so as to read as follows: — Section 121. A docket for, and 
a record of all proceedings under sections one hundred and thirteen to one hundred 
and twenty-four, inclusive, and all papers in connection therewith, shall be kept by 
the clerk of the court in which the justice making the commitment under said sections 
sits. The clerk shall receive and keep on file the original application, the certificate of 
physicians and the copy of the order of commitment attested by and with the return 
thereon of the officer or other person serving the same. [Approved May 16, 1923. 

Chapter 467. 

An Act relative to the Commitment of Insane Persons to the Bridgewater 
State Hospital, and to the Transfer or Discharge of Inmates thereof. 

Whereas, The deferred operation of this act would tend to defeat its purpose, there- 
fore it is hereby declared to be an emergency law, necessary for the immediate preser- 
vation of the public peace, safety and convenience. 

Be it enacted, etc., as follows: 

Section 1. Chapter one hundred and twenty-three of the General Laws is hereby 
amended by inserting after section twenty-two the following new section: — Section 
22 A. The department shall, subject to all provisions of law now or hereafter in effect, 
have the same supervision over the commitment of insane persons to the Bridgewater 
state hospital as it has over the commitment of insane persons to other state hospitals 
under the provisions of this chapter; it shall have the same authority to discharge or 
transfer inmates of said Bridgewater state hospital who are not under sentence, or 
whose sentences have expired, as it has to discharge or transfer inmates of other state 
hospitals. In construing this section a maximum and minimum sentence shall be held 
to have expired at the end of the minimum term, and an indeterminate sentence, at 



98 P.D. 117. 

the end of the maximum period fixed by law. But the said Bridgewater state hospital 
shall remain under the jurisdiction of the department of correction and the control 
of the superintendent of the state farm. Nothing herein contained shall be construed 
as conferring on the department of mental diseases any authority to change or 
vary, except as herein provided, the decree or order of a court having competent 
jurisdiction. 

Section 2. Section one hundred of said chapter one hundred and twenty-three is 
hereby amended by inserting after the word "hospital" in the sixth line the words: — 
or to the Bridgewater state hospital, — and also by inserting after the word "limita- 
tions" in the same line the words: — , subject to the provisions of section one hundred 
and five, — so as to read as follows: — Section 100. If a person under complaint or 
indictment for any crime is, at the time appointed for trial or sentence, or at any time 
prior thereto, found by the court to be insane or in such mental condition that his 
commitment to an institution for the insane is necessary for his proper care or observa- 
tion pending the determination of his insanity, the court may commit him to a state 
hospital or to the Bridgewater state hospital under such limitations, subject to the 
provisions of section one hundred and five as it may order. The court may in its dis- 
cretion employ one or more experts in insanity, or other physicians qualified as pro- 
vided in section fifty-three, to examine the defendant, and all reasonable expenses 
incurred shall be audited and paid as in the case of other court expenses. A copy of 
the complaint or indictment and of the medical certificates attested by the clerk shall 
be delivered with such person in accordance with section fifty-three. If reconveyed 
to jail or custody under section one hundred and five, he shall be held in accordance 
with the terms of the process by which he was originally committed or confined. 

Section 3. Section one hundred and one of said chapter one hundred and twenty- 
three is hereby amended by inserting after the word "hospital" in the third line the 
words: — or to the Bridgewater state hospital, — so as to read as follows: — Section 
101. If a person indicted for murder or manslaughter is acquitted by the jury by reason 
of insanity, the court shall order him to be committed to a state hospital or to the 
Bridgewater state hospital during his natural life. The governor, with the advice and 
consent of the council, may discharge such a person therefrom when he is satisfied 
after an investigation by the department that such discharge will not cause danger to 
others. 

Section 4. Section one hundred and five of said chapter one hundred and twenty- 
three is hereby amended by inserting after the word "four" in the third line the words: 
— , or of the commissioner of correction and the superintendent of the state farm when 
the removal has been made to the Bridgewater state hospital, — so as to read as fol- 
lows: — Section 105. When in the opinion of the trustees and superintendent of the 
state hospital to which a prisoner has been removed under section one hundred or sec- 
tion one hundred and four, or of the commissioner of correction and the superintendent 
of the state farm when the removal has been made to the Bridgewater state hospital, the 
prisoner is restored to sanity, they shall so certify upon the commitment, and notice 
accompanied by a written statement regarding the mental condition of the prisoner 
shall be given to the keeper or master of the jail or house of correction, the superin- 
tendent of the prison, or to the person having custody of him at the time of the removal, 
who shall thereupon cause the prisoner to be reconveyed to the jail, house of correction, 
prison, or custody from which he was removed. [Ap-proved May 25, 1923. 



P.D. 117. 



99 



SPECIAL APPROPRIATIONS. 



The special appropriations for the year 1923, and for ten, fifteen, and twenty- 
five year periods, are shown in the following table : — 





1923. 


Fifteen 
Years, 
ending 
1923. 


Ten 
Years, 
ending 

1908. 


Twenty- 
five 
Years, 
ending 
1923. 




- 


$270,660 00 


$299,098 44 


$569,758 44 






194,485 00 


325,205 00 


519,690 00 


Northampton Hospital: 
Constructing and furnishing building to accom- 
modate 86 patients 

Purchase of the Courtney property . 


$100,000 00 
4,000 00 








Danvers Hospital: 
Constructing storage house for roots and vege- 
tables 


$104,000 00 
$6,000 00 


307,685 00 
460,900 00 


217,300 00 
364,100 00 


524,985 00 
825,000 00 






439.750 00 


454,625 00 


894.375 00 


Boston Hospital: 
Constructing house for superintendent 
For land taken by eminent domain . 


$15,000 00 


2.736,209 37 
400.000 00 




2.736,209 37 
400,000 00 














_ 


1,267,089 50 


517,900 00 


1,784,989 50 


Medfield Hospital: 
Installation of continuous baths 
Constructing and equipping hydriatic room 
Equipping bathtubs with automatic control 

Improvement of water supply .... 


$23,000 00 
11,900 00 

7,500 00 
4,300 00 
3,000 00 








Gardner Colony: 
Alterations in male and female infirmary build- 
Alterations in domestic building 


$49,700 00 


303,677 00 


558,700 00 


862,377 00 


$6,000 00 
47,000 00 








Monson Hospital: 
Constructing three cottages for married phy- 
sicians and officers 


$53,000 00 

$15,000 00 
2,000 00 


439.244 00 


495,950 00 


935,194 00 


Foxborough Hospital: 
Constructing an administration, medical and 

surgical building 

Furnishings for certain ward buildings 
Purchase of land 


$17,000 00 


340,245 00 


431,800 00 


772,045 00 


$130,000 00 
20,000 00 
5,000 00 








Maasachusetts School for the Feeble-minded: 
Constructing central heating and power plant . 
Constructing building for 36 employees . 
Furnishings for officers' quarters 
Constructing house destroyed by fire 


$155,000 00 

$85,000 00 
14,000 00 
5,000 00 
4,500 00 


1,233,841 72 


173,150 00 


1,406,991 72 


Wrentham State School: 
Constructing sewer beds, this amount to be in 
addition to amount appropriated in 1922 


$108,500 00 

$10,000 00 
35,000 00 


378,200 00 


537,100 00 


915.300 00 


Belchertown State School: 

Extension of water system .... 

For certain furnishings and equipment in addi- 
tion to amount appropriated in 1922 

Constructing tunnel, conduits and service line 
extensions 

Constructing electric service lines 


$45,000 00 

$34,800 00 

59,800 00 

37,000 00 
6.6.50 00 


1,154.360 00 


247,800 00 


1.402,160 00 



100 



P.D. 117. 





1923. 


Fifteen 
Years, 
ending 
1923. 


Ten 
Years, 
ending 

1908. 


Twenty- 
five 
Years, 
ending 
1923. 


Belchertown State School — Co«. 

Remodeling and furnishing employees' cot- 
tages . . . . . . . 

For the purchase and setting of additional 

Repairs to gutters and conductor pipes ^ . 


$14,000 00 

11,500 00 
5,000 00 
2,431 20 










$198,681 20 


$1,722,273 20 


- 


$1,722,273 20 


State Infirmary (Mental Wards) .... 






$120,000 00 


120,000 00 






90,000 00 


235,000 00 


325,000 00 


Hospital for the Insane of the Metropolitan Dis- 




115,000 00 




115,000 00 






600 00 




600 00 


Purchase of Boston Insane Hospital (see Boston 
State Hospital) 




1,000,000 00 




1,000,000 00 




$751,881 20 


$12,854,219 79 


$4,977,728 44 


$17,831,948 23 


Summary of Special Appropriations. 


Insane: 

Constructing, furnishing and equipping build- 
ings for patients and nurses .... 
Number of patients provided for 
Average per capita cost .... 
Number of nurses provided for . 
Average per capita cost .... 
Patients and nurses provided for 
Average per capita cost .... 
Land, buildings for officers and employees and 
for administrative purposes, including fur- 
nishing and equipment, improvements and 
repairs 


$100,000 00 
86 

$1,162 79 
86 

$1,162 79 
$291,200 00 


$3,833,009 03 
3,759 
$831 44 
777 
$910 69 
4,536 
$845 01 

$4,594,155 06 


$2,207,525 00 
2,992 
$596 27 
651 
$650 49 
3,643 
$605 96 

$1,733,886 44 


$6,040,534 03 
6,741 

$728 29 
1,428 

$792 07 
8,169 

$739 44 

$6,328,041 50 


Totals 


$391,200 00 


$8,427,164 09 


$3,941,411 44 


$12,368,575 53 


Feeble-minded: — 

Constructing, furnishing and equipping build- 
ings for patients and nurses .... 
Number of patients provided for 
Average per capita cost .... 
Number of nurses provided for . 
Average per capita cost .... 
Patients and nurses provided for 
Average per capita cost .... 
Land, buildings for officers and employees, and 
for administrative purposes, including fur- 
nishing and equipment, improvements and 


$352,181 20 


$1,421,192 00 
2,168 
$616 09 
131 
$652 67 
2,299 
$618 17 

$1,833,641 20 


$425,500 00 
840 
$435 12 
82 

$731 70 
922 
$461 50 

$359,400 00 


$1,846,692 00 
3,013 
$564 61 
213 
$683 09 
3,226 
$572 44 

$2,193,041 20 


Totals 


$352,181 20 


$3,254,833 20 


$784,900 00 


$4,039,733 20 


Epileptic (sane): — 

Constructing, furnishing and equipping build- 
ings for patients and nurses .... 
Number of patients provided for 
Average per capita cost .... 
Number of nunses provided for . 
Average per capita cost .... 
Patients and nur.ses provided for 
Average per capita cost .... 
Land, buildings for officers and employees, and 
for administrative purposes, including fur- 
nishing and equipment, improvements and 
repairs 


$8,500 00 


$87,000 00 
150 
$560 00 
4 

$750 00 
154 
$504 93 

$79,622 50 


$152,550 00 
192 
$732 03 
27 

$444 44 
219 
$696 57 

$63,350 00 


$239,550 00 
342 
$656 57 
31 

$483 87 
373 
$642 22 

$142,972 50 


Totals 


$8,500 00 


$166,622 50 


$215,900 00 


$382,522 50 



1 $15,231.20 of these three items to be taken from item 507 of General appropriation of 1922 for the extension 
of fpur track and construction of coal trestle. $3,700 of the amount for additional boiler was transferred by 
the Governor and Council from the appropriation for extraordinary expense. 



P.D. 117. 



101 





1923. 


Fifteen 
Years, 
ending 
1923. 


Ten 
Years, 
ending 

1908. 


Twenty- 
Years, 
ending 
1923. 


Inebriate: — 
Land, buildings for officers and employees and 
for administrative purposes, including fur- 
nishing and equipment, improvements and 

All classes: — 
Constructing, furnishing and equipping build- 
ings for patients and nurses .... 
Number of patients provided for 
Average per capita cost .... 
Number of nurses provided for . 
Average per capita cost .... 
Patients and nurses provided for 
Average per capita cost .... 
Land, buildings for officers and employees and 
for administrative purposes, including fur- 
nishing and equipment, improvements and 

Totals 

Average amount appropriated annually 
Purchase of the Boston Insane Hospital . 

Totals 


$100,000 00 
86 

$1,162 79 
86 

$1,162 79 
$651,881 20 


$5,341,201 03 
6,077 
$747 91 
912 
$872 93 
6,989 
$764 22 

$6,513,018 76 


$35,517 06 

$2,785,575 00 
4,024 
$596 11 
760 
$651 94 
4,784 
$583 27 

$2,192,153 44 


$41,117 00 

$8,126,776 03 
10,096 
$677 01 
1,672 
$772 48 
11,768 
$690 58 

$8,705,172 20 


$751,881 20 
- 


$11,854,219 79 
$790,281 31 
$1,000,000 00 


$4,977,728 44 
- 


$16,831,948 23 
$673,277 92 
$1,000,000 00 


$751,881 20 


$12,854,219 79 


$4,977,728 44 


$17,831,948 23 



102 



P.D. 117. 



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Disposiil 
System 
and AH 
Connections. 


$G99 28 
15,326 95 
21,580 04 
9,700 00 
22,719 95 
37,008 09 

46,574 55 
41,008 07 
20,810 72 
21,389 67 


$236,817 32 

$5,645 40 
9,118 14 
25,000 00 
27,735 06 


$67,498 60 
$304,315 92 


Plumbing 

and 
Plumbing 
Fixtures. 


$3,083 56 
17,465 16 
2,355 77 
115,384 31 
35,590 71 
33 950 00 

ttUfJUXJ \J\J 

- 

47,657 46 
30,364 40 
5,709 93 


$291,561 30 

$25,897 39 
33,677 63 
61,748 82 
48,520 00 


$169,843 84 
$461,405 14 


Lio;hting Sys- 
tem, includ- 
ing Engines, 

Dynamos, etc. 


$24,250 00 
6,190 91 
97,769 55 
35,054 04 

143 49 

22,713~55 
10,304 81 
26,587 06 


$365,924 41 

$17,431 79 
18,253 46 
41,696 11 
20,809 05 


$98,190 41 
$464,114 82 


Heating, 
Ventilating 

and Re- 
frigerating. 


$186,725 35 
34,144 00 
49,423 33 

144,801 45 
50,348 05 

279 894 83 
74',177 42 

127,447 13 

102,529 23 
81,544 88 

128,456 95 


$1,259,492 62 

$80,672 34 
150,255 79 
149,948 71 
235,080 72 


$615,957 56 
$1,875,450 18 


Water 
System 
and Appur- 
tenances. 


$135,562 05 
23,766 32 
27,590 77 
98,982 20 
91,429 90 
29 537 46 
27;346 84 
159,393 70 
30,361 18 
5,534 05 
55,103 92 


$684,608 39 

$24,366 04 
28,250 06 
29,243 89 

120,566 67 


$202,426 66 
$887,035 05 



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Ill 



Garage, Stable and 
Grounds. 


Increase. 


$1,008 081 
52 711 
3,726 65 
5.715 161 
1,246 29 
5 24 
5,050 18 
3,910 24 
664 90' 
159 01 1 
1,045 09 


$7,383 83 

$730 45 
629 42 
71 32 
359 21 1 


$1,071 98 
$8,455 81 


Amount. 


S!l,412 71 
5,235 35 
8,724 35 
4.687 12 
9,156 05 
54 39 
8,416 38 
3,910 24 
5,465 36 
5,790 68 
4,291 39 


$67,144 02 

$7,085 40 
682 62 
5,636 44 
551 35 


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Amount. 


$26,802 43 
22,716 50 
29,887 21 
46.024 53 
35,777 17 

13,093 20 
28,631 15 
27,700 70 
17,943 84 
35,544 86 


$284,121 59 

$22,270 94 
57,280 98 
20,986 24 
16,321 63 


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t~.030500»OCOcDcqc^C<l'* 
lOcD>— ■lOi000020CMC<lCO 



Oi CO CO 

t— 

CM 02 lO lO 
— CO CM 

cor^o.^ 



O ?i 5 tc --C-s ►r' »; 1^ O 

.. « e S £ S'^'^ c~ o 'r 



nil 



sis 



112 



P.D. 117. 



CD 0< 
C2 ( 



• fO O O lO CO 



en O CD lO 00 



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■iCOCD-^CiTj<Ot— t^05 
< CM OO O -^1 



O O o 
03 CD O 



CD -"tl I>- 00 

CD CO O 
1— I 02 lO CO 



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OO-^-ctii— ICCOOCDOIOOOO 

R. ^> ^> °i 'R. 



~ c. m CO ca 

OO OO OO CO OO lOO I--rGiO lOlo" 
■^OOOC^OCO^COrtOO^ 
^ CM CM CO CO CM CM 1-1 



^ ^ Cq 

C5 00 CM 

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c<iOoococoir^02CO( 

0;t^-*C0CMOCDOi 



CM CM lO 
<-i CM O ■'tl 

CO ^ >o o 
co__ 



OiTtlcDT-lCOOOCDcOOCDCM 
lOr-H.-HrtCM'-iOOt^ClCM-ttl 

t^t^CO-^CMiOCO^OOO 
■^COTtlOO^O-^00;cOCD^O 
CD_^ CO_ CS O CM_^ CO__ t-~ 

cd' cs" i-T »-h co' ci" cm' c<r 



t^—i f^'^ti _"S 

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P.D. 117. 



113 



00(M00t^0000>0(Mt0OO5 



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CM 00_^t^_^r^ 

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CJiO'*'«*<0-HCOI:^t^ior^ 
lC-<j<-HOt^COO»OI^'*l>C 


o 

CO 


.-1 VO lO 05 
CM CO 05 CM 


o 


o 
t— 


COCOOOI^OlOOSOlOOO 

•^O^io05CMTt<cor^OC5 
COOcOcOtr^Tti'-H_.— ico-^CM 


o 

CM^ 


CO lO O 
CO CO 
CM_^CO t>-,^ 


CO 
00_ 


2 


t~ CO ^ CM CO cTcO CM C5 
M<CO>0 000— iC5t^lO'-<-^ 
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CO 

t>. 

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05 i-O <— 1 o 

CM OO lO 


co" 

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CO T-^ a CO 1— 1 T-< 




^"""'^ 




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CM 



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iill llllpl 



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114 



P.D. 117. 



5 I 



. o i-~ «o < 



U5 03 ^ OO iC Tj< 



CO O ^ 
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CO Tf lO 05 



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o lo 

oo ^ 



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a.s 



^ CO CO O C l ^ < 



>rM~- O T-( . 



Ot^C^OOC^lO'— 'CDCQCO 
•^CDOO^C3C3CO-»J<COOOCO 

oc(^osco5occ-»i-ocr. t^i-i 
cc co__ ,-1^ C<i (M_ -^^^ oq^ O 
i^-' »o' t^' t-" i!7 c^' co" o c<r lO* 

^CO(M«DeOt^ .-I (M r-H 



<M Cd 02 CO 



a> >o oo <M 

T- CO -^J* 

c--_o o 



oo 

05 CO 



Oi:^tf<-^coco^OiO.^O 



) (M lO iO oo CO 



1 O CO 

I O 



oo iC O 



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03 • 



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= g 5 ^ g >-2^ g S 



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03 Ph 



^ fefi 



P.D. 117. 



115 



2 fL 



I O O 0» lO (M Oi IC 



> t ^ 



CO 00 O 05 

OO 05 00 



^ 00 

co'oo 



GO CD 05 



.-H 1*1 OO 



00.-<(M-<t<00^>0Oa>-tiC0 
00i0(M05t^OO-^OC0'<»< 



O CO lO 



Tli O ^ 



05 c 



^1 



I >C ■>*< O O ';D 05 O 
• "5 0> O (M CO 05 



o 

OO (M 

o 



So* 



>— I O 05 00 
05 1(5 05 O 00 C^) 

005 CO -rf Oco 
CO CO CO o t- 

««io -"iti iM 



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t~~ o 

—1 o 



lf5 —( ^ 



fas -3 

o g g g^a.H g'g':^ 



c ^ o c-S 



a 

a 



C-3 
ai-r 



P.D. 117. 



Religious Instruction. 


Net 
Weekly 

Per 
Capita 
Cost, 
1923. 


<M(MCO<M<MCOev5<M<M'*eO 

ooooooeooooo 
o 


CO eo CO CO -H 
o oooo 
o o 


$0 02 

$0 02 

$0 02 
02 


$0 02 
$0 02 


Net 
Expenses. 


$1,840 00 
1,620 00 
1,230 00 
1,721 47 
1,362 00 
2,050 00 
930 00 
1,380 00 
2,010 00 
1,603 71 
1,415 50 


$17,162 68 

$1,525 92 
1,990 00 
1 200 00 
'l70 00 


$4,885 92 

$22,048 60 

$722 79 
1,079 22 


$1,802 01 
$23,850 61 


Receipts. 










Gross 
Expenses. 


000-hC<IOOOOC010 
•^(MfOfMtCiOCOOO— 

oo_co CO CO o 05 CO o_tc 

^,_^^_CO rtCO-HT-H 


$17,162 68 

$1,525 92 
1,990 00 
1,200 00 
170 00 


$4,885 92 

$22,048 60 

$722 79 
1,079 22 


$1,802 01 
$23,850 61 


Personal Services. 


Net 
Weekly 

Per 
Capita 
Cost, 

1923. 


$2 87 
2 92 
2 53 

2 90 

3 14 

2 84 
30 85 

3 03 
2 77 

4 51 
2 99 


$3 11 

$2 95 
2 92 
2 71 
5 36 


$3 06 

$3 09 

$3 01 
1 70 


$2 30 
$3 03 


Net 
Expenses. 


$315,867 80 
212,064 48 
139,855 57 
249,808 35 
216,051 92 
312,432 13 
126,601 64 
228,980 50 
244,794 24 
132,701 13 
141,206 01 


$2,320,363 77 

$169,912 22 
234,982 77 
172,844 25 
91,582 66 


$669,321 90 

$2,989,685 67 

$113,344 79 
76,554 83 


$189,899 62 
$3,179,585 29 


Receipts. 


1 1 1 1 1 1 1 I 1 1 1 








Gross 
Expenses. 


$315,867 80 
212,064 48 
139,855 57 
249,808 35 
216,051 92 
312,432 13 
126,601 64 
228,980 50 
244,794 24 
132,701 13 
141,206 01 


$2,320,363 77 

$169,912 22 
234,982 77 
172,814 25 
91,582 66 


$669,321 90 

$2,989,685 67 

$113,344 79 
76,554 83 


$189,899 62 
$3,179,585 29 


Average 
Number 
of 

Patients. 


2,113.09 
1,396.31 
1,061.21 
1,658,82 
1,323.79 
2,114.05 
78.91 
1,454.99 
1,696.84 
565.42 
907.31 


14,370.74 

1,107.00 
1,546.00 
1,228.60 
328.80 


4,210.40 

18,581.14 

723.00 
853.90 


1,586.90 
20,168.04 


INSTITUTIONS. 


The insane: 

Worcester Hospital 

Taunton Hospital 

Danvers Hospital 

Westborough Hospital 

Boston Hospital 

Psychopathic Hospital 

Grafton Hospital 

Medfield Hospital 

Gardner Colony 

Totals and averages 

Miscellaneous: 

Monson Hospital 

School for Feeble-minded at Waltham 

Wrentham School 

Belchertown School 

Totals 

Totals and averages for hospitals and miscellaneous . 

Mental Wards, State Infirmary 

Bridgewater Hospital 

Aggregates 



P.D. 117. 



117 



CO 00 00 



C5 O 00_ kO t-- lO CO 
•.^r 05 O" OO" r-^ -r^ -h" CI OO' (M" 



CO O lO <— I 

1-H ^ O 
^-HCO CO 03 

CO O 0> CO 



CO CO 
CO CO 



coict--ooa>02oo(>Jt^ 

cO-^COOCOCOOOt^t^ 

COOCOCOCO-rtiOOt^t^ 
CDO^OOJO^C-KM 

CO coc<r^co" 



o o ot^ 

i-H 00 lO 

CO CO CO 



CO 02 lo 

O lO O -fi 
CO O CO o 



CO 00 CO o o< 



o 



• COlOcOOOOOCOrJlt^TtH- 



O CO ^ »o 



r-iocooococqcooooo^'ti 

00^00002lO.-cOCOCOOO 

c^ooa5co0'#co^05>-o 

lO_ t-__ O '-'^ 0_ CO (M_ C<1_ 
Oo" co" in co" 00 Oo' o" J>r Tji rj^" 



CM CO o m 

05 CO ^ O 

O O CO ^ >o 

^ CO Tt( ^ r-l 



^ O CO CO 

O 1-1 ot^ 

CO O 05 CO 



■I .1 

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iill>lllllll 



6 _ 

lilil 



«2 



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eg 

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118 



P.D. 117. 



Net 
Weekly 

Per 
Capita 
Cost, 1923. 


O 1-1 


-tKC 

O O 


$0 43 

$0 41 

$0 38 
16 


o o 

8 8 


Net 
Expenses. 


S39,5G9 74 
31,618 86 
23,136 58 
34,758 93 
29,372 71 
47,518 14 
7,004 71 
27,521 49 
31,431 16 
15,816 00 
17,506 71 


$305,255 03 

$24,184 17 
32,847 73 
25,549 10 
11,608 73 


$94,189 73 

$399,444 76 

$14,302 81 
7,162 00 


$21,464 81 
$420,909 57 


Receipts. 


<M »n T-i oo ic-.* 

OO »0 CO T-l (M (M 

«^ 


$282 87 

$43 50 
190 25 
31 48 


$265 23 

$548 10 

$14 04 
63 76 


$77 80 
$825 90 


Gross 
Expenses. 


$39,652 25 
31,620 95 
23,141 58 
34,768 70 
29,423 87 
47,586 33 
7,004 71 
27,536 49 
31,456 08 
15,816 00 
17,530 94 


$305,537 90 

$24,227 67 
33,037 98 
25,580 58 
11,608 73 


$94,454 96 

$399,992 86 

$14,316 85 
7,225 76 


$21,542 61 
$421,535 47 



00--(^C<l.^-*-rtlCO^COC^ 

(M—HC^jkooit^iot^cqcoi^ 
1(5 CO o r— lo r-i »o OO o lO 

00 t>rcO lO CO 051000 



. >0 -^t* 05 »0 (M 00 



■ ooa>05c:rs-+icocoo50 



en >o o o 



1-1 ^ 

■«* CO 00 CO 
■<*< (M 05 CT> 

o'l-^-'co'ci 



lO OO ^ 




P.D. 117. 



119 




120 



P.D 



00 1-1 

T»< O 

o ^ 



I 00 o o o 
1 OO OO .-1 >— I 



05 05 lO 
05 O 
CO 



2 ^ 



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CO >— I CO ffO >f5 



O O 



O 63 



coi— isocooiooioi— o^ocq 

00 00 00O500 00O500 00 00 00 



o !M 05 en 



& p 



00 00cO.p-lc<Jl0-Ht^OC<l<M 
t^OC<lC0000000'>rt<-t<0;«0 
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s 



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Ol (M CO 

oq^oq <M_^io 
■^'cot-'c^f 



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P.D. 117. 



121 




122 



P.D 



117. 




P.D. 117. 



123 



I <M ■Tti lO fO - 
I Tt< O O CC "-I < 



>cr>^ocDoOCT>t:^io-rt<«3 



-* CC <M 
CO CO CO 



Net 
Expenses. 


$716,300 00 
485,764 84 
341,974 47 
612,122 82 
526,831 01 
751,897 06 
one ot;a 

510,094 42 
576,554 16 
308,281 57 
314,982 37 


$5,353,761 48 

$370,855 89 
539,087 84 
469,010 40 
226,519 39 


$1,605,473 52 

$8,959,235 00 

$281,914 90 
204,038 34 


•>*< 

CO oo 
lO oo 

05 rH 

00 


Receipts 
from Sales 
or 

Refunds. 


$1,184 28 
1,252 71 
1,126 32 
1,394 14 
3,773 18 
1,100 41 
200 65 
3,612 59 
3,269 79 
1,332 94 
5,245 23 


$23,492 24 

$1,785 03 
2,805 15 
1,035 81 
108 57 


$5,734 58 

$29,226 80 

$711 88 
3,085 98 


$3,797 88 
$33,024 68 



go 



%< 6 



COCOCOCOt^t^lOCDCOOCO 



CO O CO 
-rt< 00 OO 

CD CO CO 



<M 00 



cooiM^'Hioi^oor^coos 

lf5t^(Ni-lt^00O5t^lOlOt- 
CDCDCOt~-t>.COOCOCDOCO 



lO I O CO 



lO CO 



IS 



I o 03 CO 



oi CT CM cn 



CO 00 O CO 

c^q'T-To CO 

-"tl (M 
CO >0 Tl( (M 



00 CO 



oo o 



.. « !3 S «5 2 

2 «2 S « S 



S"c2 p 



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a -3 

a CO o rj-^ H 



g 
o 

C 

"3. 



a 

to 

G . 

>— 1^ 

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CO g 

ll 



124 



P.D. 117. 



00 CO Its 05 



<M lO IM 



o a 



C<lr~r-l»*ICOOa3O00OC»3 
IC in 1-h CO 00^'— I CO lO CO 00 

i-*c^ OiOcocOT-r-^jTcococ;'" 

COOt^<MCO>O^COOOT-^iO 

t— »oirooiot~<Mioiococo 



4> 



,-(0>-Hi-IC500UOOCO(M-^ 



1 00 CO lo o> 

) O r-l 00 O C5 
O Oi <N Tj< CO 



05-*>OrtOO-^0'-iCD-^<:D 

00- *<I^OOC<IOOt^C^OC^OO 

-<j<_co_^'0^o^t>-^r-_o CO CO i-H ^ 

1- Tcsi (M O csf CO "-Tco CO CO o 

coor^cMcoiO'— icooot— iio 

l^-lOCOCDlOt^C^lOlOCOCO 



cq lO 00 ic 



•rtl lO O CO 

o> CO 

OO CO o 



a) 
a 

1 g 

-si 



a 

a 

it 

II 



P.D. 117. 



125 



GO 



c ^ £ - 1 



Q 



I O M • 

^ 00 f- ■ 

• tS lO O 50 1^ CO I 



l0Ol^O00'0t^C0O'»t<O 
t^OO'.3>-*t^05COC<C05DCO 

O CO 



«t^OOOC^O>^-«Ot^.-icO 
CO.-HOM-t'O'-ilCCOCOlM 

«<0 lO ^ 



. CO 00 CO »C C3 «o 



■^t^05coaiiM'«**ooooc5co 

COCDCO»CCOl«COCOCOC<)CO 



CO CO 00 CO 



05 CO oj 

O CO CO 
t - 00 CO 



<M CO 

OS M CO 05 
lO O CO ^ 



CO CO M 00 
CO CO 00 C5 



Per Capita 
Valuation. 


$1,442 12 
704 00 
1,179 42 
1,737 77 
1,064 21 
1,699 65 
9,117 03 

1.149 25 
1,154 70 
2,501 52 

1.150 97 


$1,390 06 

$929 78 
938 00 
1,209 21 
4 "^84 QQ 


$1,284 16 
$1,366 06 


Total of Real 
and Personal 
Property. 


$3,047,.346 59 
983,008 40 
1,251,618 14 
2,882,657 04 
1,408,799 70 

719,425 31 
1,672,160 57 
1,959,375 77 
1,414,409 45 
1,044,290 57 


$19,976,240 60 

$1,029,276 21 
1,450,160 29 
1,485,641 65 
1,441,785 95 


$5,406,864 10 
$25,383,104 70 


Average 
Number 
of 

Patients, 
1923. 


2,113.09 
1,396.31 
1,061.21 
1,658.82 
1,323.79 
2,114.05 
78.91 
1,454.99 
1,696.81 
565.42 
907.31 


14,370.74 

1,107.00 
1,546.00 
1,228.00 
328.80 


4,210.40 
18,581.14 



H 



2 2 



J2 'rA^ I- P S i2 



126 



P.D. 117. 



o ^ 

Pi 



g o 2 . -S 



-« 0> 

o"»o to" 



O <M 05 
lO oo « 



« (» o c» CO o ro 



O O 00 o 
O CO 

O 



«5 < 



- — o o C5 05 00 

t'j us O '"^ OO 00 O ^ 
OOCOOOr^dO'-i— ICO'— 1^ 



CO <M O C5 



<M to 

oo to o 



f CO Oi 



OS to CO CO 00 . ^ 
»-«i0020C^COiOOiCiM 
OO-^^O'*!^ — -^lOtO 
O O CO -HiOlO orTjH"oo c^", 
COO^O-iOOlOtOCJ-i'L., 
t^iftCOOiOt^lMiOtOiOTti 



-^i>.eotootoeoi>.>oc<Jio 

OICOC.J'O'— lOCO"— lOSt^tO 

t^i0O-^'O'*<»0C^'-Ht000 

CO-h;^02i002COCO-^OC<1 

ir<i.— i»otoo5-^iOtoc<)»-Tt< 
»o oT ^* ci" "-jT o" 



o 

CO CO 



-e a 

so 



£-5 s 
2>r 



CO 1-1 ifS - 



I CO O 05 < 



O O 00 ^ GO t'- 

05 CO Tfi cn 00 00 



^ c<) O urs 
00 O Tf" 

C32 OO 
O Oo"oo"oO I--^t-~ 0> <>f O 00 <m' 
f^^j^^^tO 



O to CO CO 



CO lO O (M CO >— 1COOO<— 1 

CO 0> CO O OO 05 

co" i>.''-<j<'c^ otoo'io 

lOCfl-^ CO 00 



^ o 



aT3 

O 53 

ii 

II 
12 



T3 « 

i ^ 

.2 a 



Q 



all 



o — " ^ ^ "2, 

^ 5 o 3 S 8 >.2 « g 53 



a -s 



03 



c8 O 

1 



P.D. 117. 



127 



$603,880 73 
515,440 09 
683,744 87 


$1,803,065 69 

$205,156 71 
11.989 36 


$217,146 07 
$8,072,790 04 


$18,905 28 
6,104 96 
1,140 89 


$26,151 13 

$11,065 44 
91 15 


$11,156 59 
$740,917 46 


$622,786 01 
521,515 05 
684,885 76 


$1,829,216 82 

$216,222 15 
12,080 51 


$228,302 66 
$8,813,707 50 


$500,909 77 
422,613 34 
203,760 56 


$1,127,283 67 

$192,772 88 
12,080 51 


$204,853 39 
$6,961,281 15 


$40,983 22 
47,432 87 
25,763 71 


$114,179 80 
$18,039 90 


$18,039 90 
$704,241 76 


$80,893 02 
51,498 84 
455,361 49 


$587,753 35 
$5,409 37 


$5,409 37 
$1,148,184 59 


Feeble-minded: 

(School for Feeble-minded at Waltham 

Totals for the Feeble-minded 

Epileptic: 

Monson Hospital ''sane) 

Hospital Cottages for Children 



128 



P.D. 117 



'-H O 00 

t- ^ 05 
00 <M 



CO <M 

to a> 
a> 00 



C<I CO 



,-( o 



Total of 
Live 
Appropria- 
tions. 


$13,131 30 
13,674 60 

104,000 00 
95,142 19 
24,828 55 
57,110 39 

74,150 41 
125,250 74 
486,948 89 
146,432 67 


$1,140,669 74 

$21,221 68 
658,760 25 
233,622 59 
104,110 21 


$1,017,714 73 
$2,158,384 47 
$600 00 


New 
Appropria- 
tions 
for 1923. 


$104,000 00 
6,000 00 

15,000 00 

49,700 00 
155,000 00 
53,000 00 


$382,700 00 

$17,000 00 
198,681 20 
108,500 00 
45,000 00 


$369,181 20 
$751,881 20 


Balances 
brought 
forward 

from 
Previous 

Years. 


$13,131 30 
13,674 60 

89,142 19 
24,828 55 
42,110 39 

74,150 41 
75,550 74 
331,948 89 
93,432 67 


$757,969 74 

$4,221 68 
460,079 05 
125,122 59 

59,110 21 


$648,533 53 
$1,406,503 27 
$600 00 



■ -t -I ■! • "3 • 



^t5 o 
. " S 2 



2 3 <P 2 C G o' 



8 c 



P.D. 117. 



129 



1-^ 



o 



CO cc »o Cfl 

o o o 



«o lo o 

>0 05 00 -H 



lOcD CO 



CO ^ 

C5 00 
CO t^" 



«0 >0 (M 



O O lO 

O »0 Oi C5 Cfl 
00 O 05 



00 lO CO CO 

oo o 

"5 O O OO 



CO CO o> 



a o 



CD O CO 



. CO c 



»0 O IC OO CO 

•<*i CO lO O (>J O — I O i-H 

CO CO CI C:. CM CO CO CO O 

c^Tco i^T-^-csT o'oocooo 



lO O 



lO 00 o oo 

CO 00 
00 lO 05 
CM OO rJH^ 

oroo'cr^"" 

»&iO00 o 



I O 00 
I CO 00 



1 ^ 

o oQ a " r-'S.-^ S" Jo Wo 

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I g s J2 



130 



P.D. 117. 



-^1 



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I <M <M CO 1-1 ^ 



8 S 



o 



o «o C<l o 
05 o 

(M (M <M 



COO5C£)<M00CO00 00 00»O»O 



00 00 O 
>o o> OO 

»« <o (M 



. 00 05 ic o «o T 



- -t 1 



iffl MO ^ 

2 s;i g fl o 

I- 4i o 



'3 

•a -o I 

1 



P.D. 117. 



131 



2:S S a 
O 



.co--<-*co»ooocooo 



O O CO -H 



P fi £ 

r* G ai 



<3o o Ti< 



=3 . 



--Si 



CO »0 05 



C<lif50050(M»OCOOt:^0 
(M ^ ,^ ,^ (M C<l (M ^ 



05 05 05 (M 
O t» 

O lO 



<M <M 1-1 (M <M 



I >o 00 t>- CO »n 05 o 



CO o 




-3 
C 



5 



CO 



132 



P.D. 117. 



i3 fl^c5 o 



O X 



O CO 
O C5 



o ^ ^ o 



O ^ O ' 



I t~ lO CO (M »^ 



03 « 1^ « to 

|e|o| 



^1 



T-l(MOOOO<MTf(MOCC 



t^t^asJ^ooocococoiMt^ 

O3iOCOCO»O00(M»OiOC^-* 



02 <M -^i O 
O 05 »c 



« g s 



) CO ^ 
5 ->1< rfi 02 

S (M O 



00 lO 1 lO CO r-l CQ 



q3 ce O) 

"is 



< 00 ^ rfl IC <M CO 



o ^ CO 
Tf< oo CO 

Ttl C<J i-l 



t^OOOOt^cO-*iC500-*05"-0 
Cat^lOOOCO-HrtcOt^COlO 



■ 1 '-i '3 



s 

-pi' 



IIP mill 



■5 



P.D. 117. 



133 



Average 
Weekly 
Per Capita 
Cost. 




00 QO 


$1 32 
$1 25 


Average 
Monthly 

Com- 
pensation. 


$64 70 

64 96 

69 69 

67 45 

65 48 

66 19 

68 95 
66 51 
63 93 

70 64 
62 92 


$65 94 

$67 51 
62 16 

59 28 

60 05 


$62 34 
$85 03 


Average 
Number of 
Persons to 

One 
Employee. 


11.34 
12.74 
19.38 
13.06 
13.28 
11.70 
2.05 
14.81 
12.56 
11.19 
13.91 


12.89 

12.48 
10.34 
11 14 

9.78 


11.02 
12.42 


Average 
Number of 
Persons. 


186.29 

109.56 
54.75 

127.01 
99.64 

180.65 
38.33 
98.21 

135.02 
50.52 
64.40 


1,144.38 

88.69 
119.42 
115 21 

33.59 


386.91 
1,531.29 


Full 
Roster. 


C<l rH (M i-H T-H 


1,701 

133 
200 
161 
51 


545 
2,246 



5r!-^ CI G 

a.2o 



5 Z 



05iot>-o0'-coc0'-iaiioo 



CO 00 lO ^ t>- ( 



CO U'5 lO 



^ CO 00 00 

o -H 

CO lO CO 



<M lO < 
02 00 02 c 
CO O CO 



1 B ^ 



|2 g o 



s 

. « c £ o! S-^ 

, *r o H (-1 



Piiiiiliili 
.illllllfillll 



llll 



•til- 



134 



P.D. 117. 



a 
o 
O 

I 

Co" 

s 



.CO 



a, 

I 

o 

1-3 



Average 
Weekly Per 
Capita 
Cost. 


CO CO CO CO ^ ^ CO 
O (M 


50 l-H 0» O 
CO d CO O 

S E 


CO M 


Average 
Monthly 
Compensa- 
tion. 


$148 21 
145 23 
155 28 
141 06 
137 46 
147 77 
145 31 

134 64 
141 12 
141 38 

135 77 


$142 56 

$138 42 
148 02 
147 40 
141 55 


$144 33 
$142 95 


Average 
Number of 
Persons. 


18.79 
14.76 
11.51 
18.69 
20.07 
13.80 

6.32 
20.92 
15.25 
10.42 

7.62 


158.15 

9.35 
14.20 
10.56 
10.69 


O 

OO 03 
<M 

■>*l O 
<M 


Full Roster. 


e<io0'>*(--focot^ioooc^05 

»-l T-H (M (M T-H T-l 


OO ^ ^rl 


lO O 



© "S a o 
•<S o 



Mil § 

g g 2 

S ® 



OOOOOO-^OO' 



• CO fM 05 IC CD »0 



I 00 CO 
I CO lO 



<C0U5OC^"50050O 



O <M (M 



00 00 OO 




P.D. 117. 



135 



ft 



i 



2 2 



i s 



55 ?i 



1 

I 



ft 



i 



i 



S S2:2S 



1 I 



00 «D :0 1-5 




136 



P.D. 117. 



<v 

o 
O 



5si 



I 

H 

n 



Average 
Weekly Per 
Capita 
Cost. 


C»05^(35i-l00 00Ot-l0O5 


$3 13 

$2 95 
2 92 
2 70 
5 35 


$3 06 

$3 11 


Average 
Monthly 
Compensa- 
tion. 


^t>-(X)CO00t^O500l>.00t:^ 


$80 91 

$79 07 
80 53 
78 12 
87 98 


$80 44 
$80 80 


Number of 
Persons 
to One 

Employee. 


«0 CO t~ O ifS O CO CO CO 


6.01 

6.18 
6.35 
6.66 
3.79 


6.07 
6.02 


Average 
Number of 
Persons. 


irtorococoi— ioooooicx3<rq 

•^(MCOiOMCO-HOOcOfM-* 


2,390.03 

179.06 
243.15 
184.37 
86.74 


693.32 
3,083.35 


Full 
Roster. 


■"tit^OCOO-*'— 1050005 

CO— ioocoo-^-*-Hior^02 

CO C^l CO CO Tj* y—^ CO CO —< 


3,300 

252 
233 
254 
126 


865 
4,165 



>> Jo 

> o S'-5 



=3 S o 

^ S £ 

> C aj 



)000(M0000 



■ 03 03 O CO 

1 (M ^ o e» 

0>C300t^COC5t^»OOC<I05 



C0C0C0C0O<Mt^CT>OO<M 

(Mcor^05r^icoocoo^'-< 

Tt<CO'-lCO-*OOOCOCOCOCO 



> O ^ lO t— 



lO CO CO <M 



$ 

„ 'a 



ill 

o 



^ « a »3 2^^ a 



c3 

'a 

0; 



03 

o 
> 

< 

T3 



. a o 

I' n c5 



, - -S0C-f3 



K s 8 c — 

S r/-) pq 



c3 3 



P.D. 117. 



137 



(Tl »-< (M (M 05 



^ S 



CO CM (M C^l CSJ 05 



lO,-iOC2TtlO(MCOOCOi-ioO 
CO T»< 50 CO OC tH rH tH 



CO 05 >0 
Tf< CM 00 
lO CO 



1 CM CM CM CO < 



00 05 
O ^ 
.-H —I CM 



It^CMOOOO-Ht^OOCOC 
iOJCO'—OOOOt-iIOCO. 
( I— I CM CO r-l CM 05 • 



O 

is? 

g o w 
iS w 

« ^ 2 
a H 



r^cMOjT-iiot— (cm>o-^cmooo 
CO 00 cr- oo lo Oi csi 02 CO CO 
Tfcoc^iostOcOrtior^osCMO 



■ O CO to CO 



00 I— I OO I 



I CM CO 05 CO t 



<< 
a s 



3 o 03 c3 - 

^- « S 

-c-CTs S . 

o.o- 



00 . 

tc c3 >- ~ 



O 

00^ 

a> (B 

S M fcD 

"cj 8 8 



.-S ^ a 



M C 



^ CO acC 3 ^ ij-^ ^' r-- w 



138 



P.D. 117 



o o 

b; K M 

H W « 

o 



OOlO CO . _ _ _ _ 



C3 
O 

O 



00 



« s 

" O 
S 

D * «; 

w o g 

O PQ 

O PL, 



I O lO oo 



OO(M000000i— (t^lOOOt^COOOOlM 



) (M e^i o> 05 

! CD r-i 05 CO O CO CO cc to t>- 



eot^icoocoo t^t^iocococ 



»oocoo>.';->#rtict^05cqcDiC(M"cti 



I CO (M CO CO I _ _ 

iOc<ico^>nco— It— icsico-^05.-( 

I O " ~ ■ " 



) 0> CO 115 t-- >£5 



■ CO C5 CO O iC 5 



P.D. 117. 



139 



I 



1 tf> lO O CO 00 



T3 



T*<0'— ilOOCi^t—iI^COOC^OOOOO 
b-* t~-" CO CO O C j" CrT Co" oi" ci" cT C^-T O CO 

^rr^-^f — CO tr^o^t^o CI t^-*t^e^ 

t^-TtieO«0»Ot^(M»0»OCOCOCO»0'*l(M 



00«C>-iCO0OlM-»tl<«C0COt^r- it^iO,^ 
^00 00CD00C0OC0C^O"#O— .oco 

1 °^ '-L o 

cT^ti 00 O cTlr^— r O -^licl O-l to O CO C5 
OcoOrtiOt-'<*<COiOOOO'^COt^ 



iOior^oooot^>ct--»t<(MC^i>- 



> CO CO CSI CO Tfl CO CO <M (M CO ' 



iCiOCO'^COrOCOCOOOOCO— 'COOlO 
■>*C^CO— Ht^OCOOiO— iCCOlOCJ-^ 
T- O CO C0__>0 -"tl CO 05_C5^CO co_o co_o 

ctT CD O* iO lo" co" oT 

COOOCOOOOOCOC5^CO'<!*<C0003CO 



■<;Ht^OOC5005-^COCOC20-^l^'-l(M 
l~-C^iOoO-«*'-">O.JO'*lcOt^-«tlCOOOCO 
cClCCOoOi-OCMt^COOCOO-^CMCnOS 



Ooor^ioc^co->#o-^co— <c^t^^«c> 

CC-*llCC005i— iCDlO<>J>-(OC>flt^C<ICD 

COcCU^OiOCOOCO< 
OO O CO 0O__ O CO o_ I 

lO c TcrcTcO (m'cO 00 Tt'cM -^'sf ■'*i'cci ^ 

>— 1— leo-"*"-— I— <c^(MTt(co-<*cocoi>-05 

CO(M.-((MCNCO^(M<M^^'-i(M^ 



c3 



cJ X' 



140 



P.D. 117 



I 



•sa{i3i\[ 



)piS8J-UO^ 



'2 ' 



^ ^ 



i.5isii"SsBSiSi 



2 SS 



r 



I 



2- 



pi 



I 



i 



I S3 



3 



1 § 



1 



1 



I 



I 




1 1 ill I i 

liiiii 



P.D. 117. 



2d 

m 



iSGiei-siiiil 



I 



1 



I 



SfS 



1 1 



I 



put; ^iSTA "O 



?5 ?5 




142 



P.D. 11^ 



I* . 

la PS 



•sib;ox 



00 t— O CO I ->*< O 



•S8I'BI\[ 



vo t>. eo 05 o 



-sg puB ^jiSTA tiQ 



»0 «5 C<l I I 



1— 1 iCi CD I O c 



I o CO (rq 



O 00 O -etl 



<M CO I '-I C 



'ti CO 00 (Tl 
CO CO 



c<i CO «5 I 



OO lO >0 C5 1— 1 C<l 



CO 00 «D CO »0 I 



lO lO c<i 05 >« o 

05 O CO l:^ 



i O CO 'J' ^ O t 



^ -rH lO 1— <M CO 



00 IM C<l O t-- 



M a 



23 5?. 



C3 

w 



I 

li 



o o 

O 4) 

si 



^2 



« S 2-2 
n3 aS 



i a5 g o 



117. 



143 



Total on Books. 


•siT?:>ox 


1,831 

464 
98 
33 
35 

147 


4,075 


1 1 1 1 1 1 




»0 03 o 
O O Tt< (M t~ 

05 (M 


1,971 


1 • 1 1 1 1 1 




«o O O O 
<M O >0 lO (M i-l ^- 
1-H »0 (M 


2,104 

1 


1 1 1 1 1 1 


Other Classes. 


•sitj'^ox 


, 1 1 O 1 , , 


O 1 1 1 1 1 
CM 


, , , , , , 


•saiBtnaj 


1 1 1 QO 1 1 1 


OO 1 1 1 1 1 






1 1 1 CI 1 1 1 


CM 1 1 1 1 1 





Custodial. 


•SITJ^OX 


T-^ O CO CO O 1 1 
lO 00 1-1 
00 CO IM 


1,843 







1^00 <M 00 CO 1 1 
05 05 CO >-l 
CO ^ 


1,048 







C<l -H »0 CO 1 1 

«iO oo 


■O 1 1 1 1 1 





School. 


•SIBC>OX 


»« in >o CO 00 ifs 1 

(M »C CO '-1 CO 

t» >o <-i 


1,541 







O CO i>. >o 1 
ic 05 I— 1 cvi 

CM 


o 1 1 1 1 1 
o 

CO 





•saiBpf 


lO 00 CM 03 O 1 
J— lO O "-H --I 
CSl .-1 


lO 1 1 1 1 1 
OO 


' 


Epileptic. 


•siB-^ox 


U3 1 1 OCM 1 1 
CO 


CO 1 1 1 1 1 





•S9][T3Tn9j[ 


CO 1 1 « 1 1 


00 1 1 1 1 1 






CM 1 1 1 1 


03 1 1 1 1 I 


1 , , , , , 


Non-resident. 


•si^^ox 


C^ 1 1 1 lO 1 1 
CM 


I>- 1 1 1 1 1 

CM 




•S9i'Bra9^ 


•-1 1 1 1 1 1 


00 1 1 1 1 1 





• 89^13 J\[ 


T-t 1 1 1 QO 1 1 


03 1 1 1 1 1 






Feeble-minded: 
School for Feeble-minded at Waltham . 

Belchertown School 

Hospital Cottages for Children .... 

Elm Hill School 

Smaller private institutions 

Almshouses and private families 1 

Totals, feeble-minded 

Epileptics: 

Public institutions for insane .... 
School for Feeble-minded at Waltham . 
Hospital Cottages for Children .... 
Private institutions 

Totals, epileptics 

Whole number of persons under supervision . 
Viz., insane, feeble-minded, epileptic and inebriate 
Voluntary mental patients (sane) 
Temporary care 



P.D. 



UOSUOJ\[ 



cx> 

ec »-< ^ 



s ^ s « 



C» CO C5 
(M -rf 

05 lO ro 



• (M IC 05 "5 to CO C^J — H 



cooit^i— ii>.'»t<t^OT-iooo5(Mc<iooo5r~ 
c^^r-t^ c<i a c<nn ^ oo 



OS O 05 o» »o " 



■p^^idsoH 



C<1 Tt< tM T-H 



•][B'}idsojj 

oiq^BdoqoAsj 



I (M T-^ r-( 



I r-H I O (M 00 OO C5 C5 

CO ^ — I 00 o 
(M »-l CO C<l ^ 



ItJ^TdSOJJ 



05 05 o (M CO to 05 «r CO CO r-i c<i (M lo 1 1 



uo^sog 



[B'^tdSOJI 

qSnojoq^sa^ 



Ot^co^Ocoi>-r^' 



IC CO 0> CO • 



OCOt^O-^COOt^CO' 



lOUOl-O -HOOCOOt--CO 



^t^COOilMCO OC^C0C0«5O 



■p^idsoH 

SJ8AUBQ 



looco-Hiot^ioiMcocor^-^^t 



O CO CO CO OO ^o- 



CO CO cq lo c 



•[■B^idsoH 

uo^dm^q'^jo^ 



oo oo o 

00 

M CO CD 



> C3 05 o r~ CO iM - 



O lO »0 05 CO CO I - 

•rt<CDt^t^"5t<CO'— lOO 1— cOOO<MI~~ 
CO ^ (M Csl ir^ 00 00 



I 00 l« CO 



COIMCOt^CO'* 



qB^idsojj 



•p^idsojj 



^ 03 (M CO t 



I ^ C5 00 o 



s o 2 



rj ^ rH rt ^ 



1^ 

<1 



C! S S 

g o > 

a-r c a s a- 8 



H c-i 



fl o 

a q = a 

o a o o 



117. 



I 05 I o <o CO CO t» CO ' 



. o <o eo CO I - . - 

CO '— I 

•»f< O CO to <£3 Q 
CO to (M «o S 

CO — < ^ CO 1-" 



■ - — ■ — ■ . ko 05 CO 



COO<MC^COOOt^iC^COO<M 
C5 O CO 00 »0 CO 



to O 00 O CO < 
t~ 05 lO CO ^ ' 
00 CO 00 



^CO'-*! I l-»t<CO<-HOO'^'Tt<|-«ti»CC»Cfl'it'OOOOCO'2COl«OOCT>IC5i:OOOOOr^-^COlCiOt^«0|CO»0»H| 

00- ^-^ -^t^Ot^iO — 00co"5Tt«tOI^rrl T»<0«0(MOi-<00000 

^ r— o • «ot^C50 

- 'Odoo-^'^oir-. t^oor^-H- - 

^OOt^OCT>c^cO CO ^ 

o «o C75 

iO'»l<^C^(M I Tj<CO^t>-COrJ< I »COOt^r~t>-Oi2t^OOt^»f5(M'«tl 1 Tt<-^C<lCJ-»ti"5Oi--00uO'-" 1 ^t^-<«« I 
^ Tj< (M T}< (M O -"ti to OO O O Tf O Oi -^J" CO »C '-^ CO O -"f ^ ^ 

lO ... Tf- 

- CJOC^OOlOCOCO tOt^»C(M- - 
^ O to Tf< CV| CM •^CO.-H'^ 

»o t>. f~ t-» 

oas^o50o>io<McootOT»<ic<ioeMtoc5t^— <to»ocMeMoi I icn-^o-^'^ooi'^i I I I I 1 

0> lO Tj< .-H to C^> 1-1 O "O O U5 CO to Tfi ^ lO O O O CO IM — ^ CO 

CMr-i-H ... 

co--oootoco omio 

00 >C CO CO y-* 

O t>. CO i-l O "U* W5 r>- CO I Tj< O CO ■«< O t-- 00 00 O CO O to CO (M -H 05 <M CM CO O >-< 05 IC ^-^ Ttl 

co<M-H to CO CO Tf< CM CM ^ ko ^ "5 o» to o CM 00 CO o CO ^ to u5 cTs o crs O ^ 00 •-I 

->r_r -$22<^'"'r-'^co»-<cMooiocM- -_r 

CM ^ »-i O CO OO o .-lOCMOO<^ i-c 

•^_OC0003^ CO^rt 

cm'-h^'cm" ^ 

eO»O00COCM-HC»»OTt<tOO5t^ I CMtOtOOOOSOj'cOO^CMCMO I OOO^t^lOUOOtO^JfiOO I 0"5 I "S 
cm CO COCOtOCO CM 00 CO to CO CM CM -^r CO 00 00 O — < CO 00 CO >0 CM »H ^ 

« •^•-iCqiOtOCsOi.^iO'^OOOO O ^ CO lO t-- 05 »-i CM 

'-' 32 03 03 ^ IC Tft Tj<05CJ3a>-^ 

.oCO-^XjCMtO.-l y-< O eO 

»-lO^05»0'^-<tO»«00t^— < I t^t0^t^U5CMOT}<tOt003t^— < I -HC0'O00r^-«»<CO"0COO5tO I tOM»-<Tf< 
CM « »-l CO «-" •— I CM 03 CO ITS 00 CO — < CM 00 CO "t* CO »o t-- I>- t— OS o to CM UO »-l »-( 1— I 
CM kO CM CM O • • ■ ■ to t>. 05 CM C« 

- -.^00 go »-< 10 «d to to 00 CM o- - 
^ o OS o "5 05 rt'^jio'^'^ 

OoO-^tOtOCS CO CM »-< 
cm" rt" 

CO Tt< 05 CO CM CO 03 00 00 O I Tt< OO tO CM OS CO CO OS TfH tO CM O I O 1^ CM tO O tO lO =0 lO OS I OS t-» I CM 

CM >— I O to CO O O OS CO CM O to o IC "5 OO O O O CO to CM o 

^ .-1 CO r-H CO to t>. ■ • ■ • ... ... ■OlO'OOOrt'-l 

CO Tj< M< CO to to OS C35 to r- oo _r 
^ J;;- OS oo 2* o CO cm oo co 

CMiftcoOlOlO •» ^ 

OOTf^tOiOi-HOOlCCOt^uOCM I ^OOCOOOI>.»-<StOOi2:Tt<COCJSt-CMOlO"3"OCJStOrtl.-<0«!f*flCMOO"5'-t 
lO — H 00 OS OS OO O OS t-- CM '-^ CO OS ■<!»< t>- m t— 00 O CO OS to CM CO 1 »0 1-1 ( 

1- H CO ^ CM U5 l>- 00 • ■ COtOt^CM^ 

_r o ITS o i« ^ to CM CO CO to - - 

^ OS to CM "5 <=> — <CM-HO^ ^ 

Ttc O »-< O ^ to OS 00 OO O I CO «C CJ3 to CO i5 iSSJSSSSOS l OS ^ CO OO O o os OS lOS^COU? 

t— ^ CO i-H i-i ^ ooo ■«}< to to to o <^ "^J^"^ to to co co cm "<j< oo oo ^-h 
ca«- "=^<^'"=f^.nt^oooo^ootOo ooo;-.'"-®-"^-'*-'" 

'=^'^^2SSS::S;2;s^ eMo>fSK»«<^'-*^-^ 

•«S^CO.^OOO CM i-H 

CM -h-HCm"^"-^ 



g Q> o 2 

<D^'*^ CD 



C c 

ft) o G aj 

H 



o c (I o o C (1) 



o . 
o 



J2 

1 = = ! 



^ *> o 



I 

ft) ■ « 0) 

a f^c e-^ c a 

0) o o 
•o o 

1 I 

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5 a 

s'^-c a 



uosuoiv 



o 3 o 



I I I I I 



diuiBd 



1 I I I 



oiq-^BdcqoXsj 



[B^idsoH 



aoi-sog 



l'8';td30H 



I I 1 I I I <M >OC^ 



[B^JtdSOJJ 



I'B^ldSOJJ 

uo^dui'Bq':^joj^ 



[B^ldSOJJ 



{■B^HdsoH 



g'a 





18.680 
9.123 
9,557 

3,006 
1,500 
1,506 
838 
400 
438 
3,844 
1.900 
1,944 
395 
182 
213 
4,239 
2,082 
2,157 
22,919 
11,205 
11,714 

339 
164 
175 
1,188 
566 
622 


■^:^T?AU(I iB^ox 


i-< <M ^ CO — < »-> CO — < <M ^ 




— 00C»3 O OOOO lO CO 00 U5 CO O »-< <3>O0 to CI 05 m r-t^ooot-r^ 

oscoirt tc (M CO >— to »« to to ^ o ^ CO »-< to 

« ^ ^ ^ <M ^^^CO 




(M 00 o to to 00 -"ti (M (M lO 00 05 OS o --H Tf «oo>r->«>oo 
— oocj >C(M<Nco.^— 'OOT»<-<«<r^ ci-^io — c-sr^ ^<m^,-h 

CI ^ CO <-H 




18,277 
8,997 
9,280 

2,786 
1.424 
1,362 
756 
369 
387 
3,542 
1,793 
1,749 
370 
174 
196 
3,912 
1,967 
1,945 
22,189 
10,964 
11,225 

266 
138 
128 
1,085 
534 
551 


-:^j'Bd3Q japun 

8 J B 3 AlIUIB^ 


lllllllll'^l-'-^l'-'OlO llil ll 
d C-l CO CO 




18,248' 
8,997 
9,251 

2,786 
1.424 
1,362 
756 
369 
387 
3,542 
1,793 
1,749 
369 
174 
195 
3,911 
1.967 
1,944 
22!l59 
10,964 
11,195 

266 
138 
128 
1,085 
' 534 
551 




COCOI tOlOI-^TflOSOilOOOOIt^t^lOOl OOOOI'^-^l 

r- to to »-< « t--. 0000 to to 

00 00 Oi Oi 


-xujgui 

'spj^AV IB^uapv 


»0 CJ CO CO CO O CO t~- CO •>*• CI OO -^J" O ICOCO 1 
COCl"^ COIM>-" COCM'-^'-H ^»0<MCi OOlOCO 

c<i tfl <M lo 


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COOOO <M 00 0> to CO -ti 00 to d 05 O a» <M 00 -"l" -^COOOOSOOi^ 
000(M OlO'^OT^^COt^iO C000^0^-0000 T-l C^r-mr^ 

to CO CO T-i — 1 r-1 rococo 



as 



C C-rl C C H 



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P.D. 117. 



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eoe«oeooo^oo>— <oO'^ eo oo oeo co o ic to 



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lO'-ieo «ocococarqost^t>.c;' 



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— < o <M O 
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149 




150 



P.D. 117. 



Table 13. — Nativity of First Admissions and of Parents of First Admissions at 
Public Institutions for the Insane and McLean Hospital. 











Pa 


RENTS 


OF 


Parents 


OF 




Patients. 




Male 




Female 












Patients. 


Patients. 




S 


ales. 






ales. 






ales. 








g 






a 


S 




g 










o 
H 


A 


o 


o 








CniV^O OL'HIcS ..... 


789 


793 


1 582 


422 


405 


648 


430 


421 


651 










1 




- 


- 




- 


iVlD&niB ...... 


4 


_ 


4 


4 


4 


8 


- 


_ 


- 


Ajsi^ (not ot/hcrwis6 spGcificd) 


6 


1 


7 


6 


6 


12 


1 


1 


2 


Armenia ...... 




1 


1 


- 




- 


1 


1 


2 


Australia ...... 








1 


_ 


1 


- 




- 


Austria ...... 


16 


14 


30 


20 


20 


35 


13 


15 


23 


SbI^iuih ...... 








2 


3 


2 


1 




1 


Cz6cko-Slovalvia ..... 




1 


1 


- 




- 


1 


1 


2 


V./ciIlcl(.l<l ...... 


120 


145 


265 


165 


167 


254 


173 


183 


277 


Central America ..... 








~ 












China 


1 


3 


4 




1 


2 


3 


3 


4 


Cuba 


2 




2 


1 


2 


3 








Denmark ...... 


1 


_ 


1 


1 


1 


2 


3 


_ 


- 


XJllglctllU ...... 


49 


48 


97 


68 


59 


103 


53 


52 


77 


Europe (not otherwise specified) 


7 


1 


8 


4 


4 


6 


2 


1 


1 


Finland 


6 


3 


9 


8 


7 


14 


4 


4 


7 




5 


7 


12 


5 


3 


6 


11 


9 


15 


LUd/ii y ...... 


13 


12 


25 


31 


27 


53 


25 


23 


36 


Greece 


24 


3 


27 


24 


24 


38 


3 


3 


4 


xj.oii<inci ...... 


1 


1 


2 


4 


4 


6 


1 


1 


2 


Hungary ...... 


2 


1 


3 


2 


2 


4 


2 


2 


4 


±ix:itXLHjL ...... 


116 


172 


288 


259 


281 


390 


329 


335 


482 


Italy 

Japan ....... 

Lithuania ..... 


72 


48 


120 


77 


76 


120 


54 


54 


78 




1 


1 


- 
1 


1 


- 
1 


- 
2 


2 


- 
3 


N^orway ...... 


5 


3 


g 


4 


5 


6 


4 


3 


5 


Philippine Islands .... 

Pnlanfl 

i vjlaliKl ...... 


1 




1 


1 


1 


2 


- 




- 


47 


22 


69 


51 


52 


92 


26 


24 


40 


PoT^ 1 1 crct 1 

^ KJl t il^tXl ...... 


14 


2 


16 


12 


11 


19 


4 


3 


7 


I^oumania 














1 


1 


1 


I^ussia ....... 


90 


38 


128 


94 


91 


156 


45 


44 


70 


OlA)I/laIiCl ...... 


13 


18 


31 


22 


19 


31 


28 


28 


45 


Spain ....... 


1 


4 


5 


1 


1 


2 


4 


4 


7 


owecien ...... 


20 


19 


39 


27 


27 


41 


OA 


25 


66 


Switzerland . 
















1 




Syria 


1 




1 


1 


1 


2 








Turkey in Asia ..... 


4 


2 


6 


3 


3 


4 


2 


2 


2 


Turkey in Europe .... 


2 




2 


2 


2 


3 








Wales ....... 








1 




1 








West Indies 


10 


15 


25 


12 


14 


25 


15 


16 


30 


Other countries 


4 


3 


7 


5 


4 


8 


2 


2 


4 


Total foreign born .... 


658 


588 


1,246 


921 


923 


1,452 


837 


843 


1,264 


Unascertained ..... 


3 


5 


8 


107 


122 


142 


119 


122 


163 


Grand total 


1,450 


1,386 


2,836 


1,450 


1,450 


2,242 


1,38G 


1,386 


2,078 



P.D. 117. 



151 



Cable 14. — Citizenship of First Admissions classified with Reference to Principal 
Psychoses at Public Institutions for the Insane and McLean Hospital. 





Males. 




TotJil.s 


iy birth 


790 


791 


1,581 


iy naturalization 


209 


179 


388 


iliens ............ 


362 


290 


652 


Jnascertained ........... 


89 


126 


215 


Total 


1,450 


1,386 


2,836 



Pable 15. — Psychoses of First Admissions at Public Institutions for the Insane 

and McLean Hospital. 





Males. 


Females. 


Totals. 


1. Traumatic psychoses 


9 




10 


5. Senile psychoses 


92 


180 


272 


3. Psychoses with cerebral arteriosclerosis ..... 


162 


170 


332 


\. General paralysis 


189 


50 


239 


i. Psychoses with cerebral syphilis 


12 


10 


22 


). Psychoses with Huntington's chorea ..... 


2 




2 


7. Psychoses with brain tumor ....... 




3 


3 


1. Psychoses with other brain or nervous diseases 


24 


22 


46 


J. Alcoholic psychoses ......... 


192 


30 


222 


1. Psychoses due to drugs and other exogenous toxins 


7 


8 


15 


. Psychoses with pellagra ....... 


1 


1 


2 


1. Psychoses with other somatic diseases 


34 


71 


105 


1. Manic-depressive psychoses ....... 


132 


182 


314 


!. Involution melancholia ........ 


20 


54 


74 


i. Dementia praecox ......... 


292 


326 


618 


;. Paranoia and paranoic conditions 


28 


46 


72 


7. Epileptic psychoses . . 


34 


28 


62 
36 


t. Psychoneuroses and neuroses . ' . 


9 


27 


1. Psychoses with constitutional psychopathic inferiority 


21 


15 


36 


1. Psychoses with mental deficiency 


40 


33 


73 


. Undiagnosed psj'choses ........ 


99 


96 


195 


I. Without psychoses 


53 


33 


86 


Total 


1,450 


1,385 


2,836 



152 



P.D. 117. 



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1 








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SB £ 3 
b n — 
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(M 1 1 


1 1 1 1 1 1 1 1 1 CO 1 












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1 1 1 ^(M jjOCOCJ C005 












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RALYS 










1 1 1 1 (M <-l 1 


1 1 


1 1 CJ ■>*< 


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1 It— l-^-HCO»OCOC^«000 

CO .— ^ <rq ^ 




1 CO 1 CO CO 1 




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1 1 1 laSt-H-rfCOICO— <05 
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a « «=• 5? 

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1 1 1 I»OI'-1'-h|C^OtJ< 


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lUMATIC. 






1 1 1 ICM|i-<l 1 llCI 


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1 1 1 1 1 1 ^ 1 1 1 1 1 










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1 1 1 1 1 1 1 1 1 O 1 














•SI'B'JOX 


fO >o 


CJ<—cOiOC->05t^CO 
ifS CM CO >-t 


35 1 
CO ^ 


1 r- 05 'M •« 

CO CO CO (M 




(M 1 O O 
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CO 

CO 

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c<f 


Total. 


'SOJtJIXIO^ 




CO 1 1 05 T*! OO CO OO CO 

lO 05 CO >rt 

(M CO 


CO CO 1 


1 -H 1 CO -fl 

<M CO 0-3 


CO •— 


i-H 1 00 00 


CO 
CO 




CO <M 
CO 


o o OO e-i lO 


O OO 1 


1 CO 02 <M 00 OO -H 
Cv| CO CI OO 


-1 CO 


1 (M 00 
<M 


o 







P.D. 117. 



153 



CTi O CO CC 



■«♦< o oo lO CO 



•« o coco 



CO -« 

2^ o 



z ;3 



I «0 CO »-< W CO »-< 



■«« CO I <M O 



s s: 



«0 — 1^ I 00 — o 



00 CI 



O lO O O t 



« u 

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X o 2 



iO I «0 CO Ci Cl I 



CI I CO C) I ^ CO CO 



CO I CO •-' CO ■ 



•SIB JO J, 



•saiBUjaj^ 



. 

Q £ z 

3 



COCJ «o 



on c) 05 CO I O O 



00 CI CO I CD o 



O CO CI 



CO CI 



OS M M 



CO I CI — CO : 



C CO 



154 



P.D. 117. 







I 1 1 1 1 I 1 leMlt^(M»H<CO-«l< 


llllllll— HOO-HllllllCOC^ 


00 


^' 




1 1 1 1 1 1 1 liCICOl l<MC«5<M 


llllllllltMrtllllllO-'f 


CO 

CO 






1 1 1 1 1 1 1 l«OI'^(M-^'«tlt^(M 


llllllll— HtOlllllllcOOO 


'O 


s 




1 1 C«3 1 ^ 1 ^ 1 CD -.f C<5 t~ «5 


ico— Hi i;cji-it^io-#<»^i icaii-ii'-iko 


"S 

c; 


C 
2: 
c 
< 




1 1 1 I'-'l-HlOO— <O0'^rt«0OC<l 


1— <T-| ICOltMCOCOl 1 1 1 l»^|50C» 

(M 


o> 


3 

?; 




1 Icol 1 1 1 iool05cciir<i-Ht^io 


1 "5 1 1 1 CO >— 1 C<l -H — H 1 1 (M 1 1 1 ifS to 


05 
05 


H Mental 

IFICIENCY. 




(Mi 1 1 1 1 1 It^liO^-HtD-rHC^ 


1 1 1 1 IC<II— <— 'lOI 1^1 1 1 IO"5 


CO 




'— 1| 1 1 1 1 1 It^li— ll— IICOO^ 


llllllll-HCSllllllllCO'>«< 


CO 
CO 






'-II 1 1 1 1 1 IO|-^I-<COOO-H 


1 1 1 1 ICNI'-ICOl l-H| 1 1 I'TflT-f 


o 


o . 




l-Hl 1 1 1 1 lO-HCOCqi ICMCO 


IIIIIIICv!— <Cq|llllll»OCO 


CO 


With 

CHOPAI 
ERIOUl 




1 1 1 1 1 1 1 ICvI — CCll 1 1^— H 


lllllll-^-H-H|||IIIICO^ 








1^1 t 1 1 1 1 00 1 1 (M 1 1 — < <M 


lllllll— H|— <IIIIIII<MC4 


o 

CM 


lOSES 
)SES. 




1 1 1 1 1 1 1 1 Cs 1 C-l 1 1 CO O (M 


IIIIIIIICOIIIIIIIICOIM 


CO 


D C 
M S 

z w 




llllllllOOIC^lltMCOlM 


1 1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 1 1 


IM 


Psych 

AND 




llilllll'-Hllll'-COl 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 ! 1 CO^ 


o 


u a; 




coi 1 1 1 1 1 loicoi.-<roOto 


1 1 1 1^1 1 <M CSl 1 1 1 1 1 1 1 




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—Hi 1 1 1 1 1 1 1 CO 1 1 CI lo CO 




oo 

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1 . 1 . 1 , 1 I -H , . , . 1 1 , CO 1 


CO 

CO 


o 

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5. z 










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coilllllloollll-^c^co 


1^1 1 1 1 IC4I^I 1 1 1 1 1 IOO<M 




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■< 


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1 i-'i 1 1 1 iioicN-Hi ir^— H 


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c'5 £ cx:-'^'^-^ 5 S c 

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.D. 117. 



155 



is 







1 1 — 'OOJ^ 1 


1 CO CO 


^M^dgiocococo^eoo 


on 

CO 


35-39. 




1 1 ^ O 1 1 


1 <ro ^co 


1 o CO c« ^ lo <-i ^ CO «o efl 








1 1 1 CM CO 1 


1 <M 
CO 


»-HC^)-XI l<M |(MC^l lOOCMOO 


to 






"-Hi 1 (M 1 


1 (MCSCO 


It^^ 1 g lO crs 'J' Tt< 00 CO o 


CO 
CM 


30-34. 




1 1 1 CO (M 1 


1 ^ CO 


1 o 1 r- M -fi o >— 1 <o 








"-HI 1 OO 1 1 


1 ;o -H 

<M 


1 1 c^) 1 ^cot^ 1 c<i 








C<1 1 (N 1 I 


1 CO (M 1 




g 

CM 


o» 

CJ 

lO 
N 


•e8IBUI9j[ 





1 cq 1 


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•S9IGI\[ 


1 >— 1 1 1 


1 (Tl O 1 


1 COOO 1 CO(M«i»<^rt<t^C5-<f 


CO 
C^l 






1 1 1 (M 1 


1 CO CO 1 


1 OO 1 g -H CO CO O O 


o 

CM 


20-24. 






1 -H 1 1 


1 OCO 1 O 1 CO-H.-HOC50C 


o 


• SSI'S 


1 1 1 (M 1 


1 (M CO 1 


1 -nr-. 1 cot-hmc<j«3oo— <cq 


o 

CO 






1 1 1 CO 1 1 


1 CO 1 1 


1 iOC>-HO-Ht^C0(M00OCq 


CO 


15-19. 







1 1 1 1 


1 •^O 1 O 1 t^C^Q-HiOCOiO 


















1 1 1 1 1 


1 CO 1 1 


1 03 -H O 1 1— ( .. t>. t>. 


CO 








1 CO 1 1 


1 -H CO 1 CM 1 o 1 1 




ir> 












A 
M 

a 






TT7T 








•saiBj\[ 




1 Cl 1 1 


1— <l l^llOl 1 l-H-H 


CM 






C fM O -H CO CO (M lO 

.-ir^-eocoiM -^CNI^ 
CO CM 


c<iiOTj<-rt<aoca--^t050coicr^ 
O — t>.»^t>.cOcocoi--c;oo 

-H CO <0 


2,836 


rOTALf 




— <oooo 1 
00 t-- — « 


CO <M ooo 
(M CO 


— ^-^C<lT«cOc000t^l«c0•O^•5 
l^00iOCMr:-{M<M-Hcocsco 
CO 


1.386 




saiB]/^ 


a oi ■— n 

05 50 OO 


1 <M 


^•^CMOIM«SCOC»-h005-*i 
CO CO O CM CO CM 'S' OS lf5 


1.450 








es . 
to.-vins 






















Traumatic 

Senile 

With cerebral arteriosclerosis 
General paralysis . 
With cerebral syphilis . 
With Huntington's chorea 
With brain tumor 
With other brain or nervous dis 
Alcoholic .... 
Due to drugs and other exogem 
With pellagra 

With other somatic diseases . 
Manic-depressive 
Involution melancholia 
Dementia pra;cox . 
Paranoia or paranoic conditions 
Epileptic psychoses 
Psychoneuroses and neuroses 
With psychopathic inferiority 
With mental deficiency 
Undiagnosed 
Without psychoses 


Total 






'-'(NeoM<»fl«Ot>^odc:0 


— c^icoM<iC5Cir^ooc3C— <csi 





156 



P.D. 117 



Unascer- 
tained. 




1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ' oi 




1 1 1 1 1 1 1 1 1 1 t 1 1 1 1 1 1 1 1 1 '-^ 1 


■sai-Bj^ 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 '-^ 1 


70 AND 

Over. 




lOOtOTflr^lrfTjfl |<MTl<T-<--rt|r-<|^0l0-<J<|o 
05 CO 1 ^ 




CO O 


CM 

m 

CM 


•satBj\[ 


l-*ffocoi»^i-HTt<i icr. -^1 1^1 1 i^-*ooloo 

to CO 1 "O 


65-69. 




CO CO 


•sa[Baiaj[ 


1 -H 1 1 1 ^ 1 1 1 .^(Mco-^^ 1 T-«-H 1 CO 1 

C^J CiJ CO 


•sa[Bj^ 


»— coc^cO-Hl |»^cOI l-^aOI^T-HC^I 1 im— Ico 


60-64. 




O Tj" ^ 1 ^ <M -.^KM 1 05 <M rtl 00 CO >-< (M !>. CO 
<M ^ 


o 


•sa^Bcuaj 


.-^ <M t-- 


•saiBj\[ 


i-HO>rtOI 1 l-^CO(M|-<*<r-.(Mt-l| 1 1 li-HCOCO CO 
.—1 CO 1—1 »-< C5 


55-59. 




I0005CSI'«*<| |T-H00C<II00Oi0C0-<C»|-<*n-^Tti00 '-0 
C<I<M T-H (sj ^ ^ ^ i t~~ 


•saiBoiaj 


ICOCOCOeOI l^-^^-^l-^OCOcMCOC^I 1 lOOIM -ti 


•sa[Bj^ 


1 ' ' ' ^ ' ■^2'^'^"' ' ' •«*l-HCOi-l ^ 


50-54. 


•siB^ox 


1-1 1 o» eo eo t>- <M 1 CO --^ O O CO »f5 OO rt« <M 
(M (M COtMCO--* 

1 


•sa^'Buiaj 


1 I COlCIM 1 C^CO-^^ 1 lOlO^C^-HTWOOirjCJOSfM 




•sai^j^ 


1-1 1 eOO0»^" 1 -^O-^ 1 i-icO»-H00if5rf'-< 1 (MOSC^ OO 
1-1 (35 


45-49. 




(M 1 <M CO --^ 1 CO I** i O CO -"tl CO ifl^ 00 
lO CO CO CO 


CM 


•sa['Braaj[ 


1 1 ic^»-<i 1C003 1 I'^oor^r^fM'i'icooiiM O 

1-1 C<l O 


•sai'Bj\[ 


1 (MCO(Mi-H 1 COlO^ 1 CO-*'J<OCO(M(M^— lOOCO CC 
Tt< <M T-t ^ 1 CO 


40-44. 




(^■^^^CO 1 1 t-- >0 ^ 1^ !>■ OO 05 00 t~ (M O IM CO 
■'J' (M Tti <M lO 

1 C<J 


•saiBuiaj 


1 1-1 05 1 1 1*1 CO CO lO T-H (~q (M ^ ^ CO T-< 1 


•sa^Bj^ 


<M 1 1 CV) 1 1 COOS 1 1 T-H CO CO 00 T-< 1 ■^■^^■^ en 
CO CO ^ ^ CO 




1. Traumatic 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis 

6. With Huntington's chorea 

7. With brain tumor 

8. With other brain or nervous diseases 

9. Alcoholic 

10. Due to drugs and other exogenous toxins .... 

11. With pellagra 

12. With other somatic diseases 

14. Involution melancholia 

15. Dementia prsecox 

16. Paranoia or paranoic conditions 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic inferiority 

20. With mental deficiency 

22. Without psychoses 

Total 



Unascer- 
tained. 




C<3 CO (M <M 


|§ 






oo 

00 






00 


College. 




CM ^ 


05 
00 




l-'fl I 1 1 1 1 1 1 l»M-<f<(M05C^l^l 1 1 1 


CO 
CO 




1 it^ooi 1 1 |io-Hi(rq^e<iooc<«c<«rtf-iiccco 


CO 
"5 


High 
School. 




(M ^ CO C5 (M 


"S 
CO 
CO 






oo 




c<iT»<oO'^eoi IcoQOI lccoo(Moococo'^POIcoirfl|-H 

1 ^ 


Common 
School. 




^t^-lt?^ ,-1 to CO Tt< O (M (M IM M 05 lO 


1,552 




•rtt^OS'^lO 1 1 COCOt^ 1 CC O O O 03 tM 00 — < o 
OSt^eO O eC 05 (M t-1 — < W5 <M 


GO 




CO O CO »-i 1 CO O U5 '-^ O — (N CO .— 1 CO O t-« 1 
•TfOC^l rtO CO -H lO ^ ^ c,5 




Reads and 
Writes. 




1 00 05 00 ^ C^l CO »-l 1 1 O 05 rtl O ^ 00 «^ »fS 
Tt<»0(M us 1-1 00 ^ C<lPO'-i 


CM 
i»< 




1 iC-HCOCq 1 (MCflcO 1 1 COC35t^O5CO00«»-l00-H»f5 
CM CO 1-c CO 


CM 
00 




1 CO0O!MC?<M 1 te> 1 1 ■'tiCMC^lOt^CO 1 t--'^00 
CM (M (M CM •«»< -H CM 


o 

CO 
CM 


Illiterate. 


•siB^ox 


i-HOCOCOl 1 ICOTftI |COCMC0"5C0O3CMlr~<OcO O5 
eOCO'-H CO »^ CM 1 r»< 

i "-^ 




ICMlOlCI 1 l^kOI IC0OCM05CMC0CMIOCMC0 
CM CM ^ 


00 




^00-^-^ 1 1 ICM05I ICOt^^CO-HCOl lOO'^CO 
— < 1-1 CM CM — H 


CO 


Totals. 


■qB^oX 


OCMCMOi— •eOCOCOCMlCCMlOTft'^t^CO — cococo»ot>- 
•rtt^COCOCM If CM -H O — < "-^ CO CO CO OS 00 
CM CO CM CM >— 1 CO CO <— 1 


2,836 




'-tOOOO I CO CM O 00 <-i -H CM "5 00 us CO CO CO 
OOt^US.-. CMCO OO U5 CM -<»< CM C<1 CO C35 CO 


1,386 




05 CM CM 05 CO 1 CM t>. i-H ■>*< CM O CM CO CO Oi — < O Ol 
^22"^ COCOCMgCMCO CM ■«}< 05 U5 


1,450 




Q 




1 1 1 1 <-H 1 1 1 1 1 1 1 CO 1 COt^ I I I I 




SCEHTAi: 




, . , . 1 , 1 . 1 , . 1 . 1- 1 , , , , , . 




<i 




1 1 1 1 1 1 1 1 1 1 1 c«s 1 teir-* 1 1 1 1 (Mrt 


CO 






»^Cv500>rt<M 1 — < 1 1 »-< U? 05 t>. ^ CO U5 !0 (M 00 
00 -HCO «D CSl 


»o 

CO 
<N 


Rural. 




1 J2J2'^'^ 1 -H 1 ^ I 1 00 l« 00 eo (>4 CO ^ CT> r-< 


o 






-lOOO-* 1 1 1 »HrH 1 1 CO O CO -H Tjt (M 1 -.l^Tjteot^. 

(M -H « IM CO 


"5 

•>*l 






05a>a>'«*<oococ<i»oo>«<M"*«o(^co'«i<t^co»-Hr^rtoo 
••9<05c^^rt T*< ^ en 5© o CO CO 5D i>- 

C^J (M (M (M »0 i-H 


2,557 


Urban. 




r^lflt^OSOO 1 05 00 ^ CO O «D CO «o »^ (M 
«OuO-<t< <M<M «0 O «jO 00 Ttl IM <N 1-1 CO 00 CO 


1,265 






00 CO »C O CO 1 CO »-< 1-H T-( 05 1-1 i-l 0> CO •«*< CO 
OO'^t^rt iM OO COOr^^CSlCO ^-ICOOO-*** 


1,292 



OlM<M05^COCOCO<M««C<l»0-<»<'<*<00<M»HCOCOCO««t;-- 

rtt^cocoe^ (M 1-H o t>. t>. CO CO CO o» 00 

IMCO(M IM T-(CO CO 



lOOOO I CO IM O 00 (M -"tl CO CO 00 r~- lO CO CO ro 

OOt^lOrH <M CO 00 »0 ^ ■<»< (M (M CO Ol CO 

r-l CO 



o 



a! <a 03 c .i: 



C 3 2 



2^ >> 

a 



P 03 



C3 (U 



o 

-2 n 



^ S--:- G m * <= 



ieMCO'*«s<ot^ooo»o»^<Mco'^>ocot^ooa>0'-<<M 



P.D. 117. 



159 



NED. 




1 «D O CO 1 
^ 


1 i-^^oot^ ioooo—< — coo 1 


1 to 1 


CO 


3CERTAI 




1 00 CO CO 1 


Ir^m^l ICOt— ICOCSfNI 


1 <M •«»< 1 


to 
to 


UnA! 




1 OOt^O 1 


1 1 l-<»«^|lO^'-<»0-^COI 


1 (MC^ 1 


o 



irt|tOO'-<05I>.Tj<| !»-(( 



Marginal. 




t^toooto^r^cn(Mo»^c<>iooor-t^t^-*t^-»i<oa5 

^ to lO to '-H »n 2 •>*i ^ Tti CO (M (M lO 


1,713 




1 OOOtOOO 1 i-H(MOitO 1 to CO O CO ifS 00 05 
00t^<M r-^■^ CO'^COCOCO'^-^'^'^iO-* 


00 




CO Tti 00 ^ 1 t— eo »^ to eo >o o 05 to to CO o 

CO00(M t-l-* t^OO-^OO-hC^ i-H C^l >0 


B 







O<M(Ma5.-<C0C0CD(M»0Cqi0-<j<.^00C^T-<t0t0C0l0I~- 

-Ht^coco<M — c o '-^ !>• ^^ to CO CO r» 03 oo 

<MCOC>^ <N ^COtO T-< 


2,836 


hi 
•< 


•S8['Bai8j[ 


»^ O O O O 1 CO <M O 00 -H ,^ ^ CO to 00 >0 CO to CO 
OOt— CO OO lO (M TJ< (M (M .-H CO a> CO 

,-1 ^ 1:0 


386 














01 CO (M 0> »-< CO 1 ■<»< <M 0. ^ <M IM to CO 05 -H 0> ■>*• 

ostooo^ eo 03 coco(MOT(Neo os »o 


1,450 



COtOtO(MeO(M I O00(M I r» 03 >0 00 <M 00 00 — CO lO 




^e^ico'^u5'.Dt--^odaio-^ 



160 



P.D. 117. 



<» 
CO 

ftn 8 



NED. 




1 CO-H tC «-l 1 


1 c« 


1 tCOcO^OCO'-iCOitXM'^ 
<M -"f CO 


o 

CM 
CM 


5CERTAI 




1 CO 1 


1 ,-.^Cd 


1 Its O CO CO »-H 1 <-lCO'^<M 
(M Cd 


(M 


UNAf 




1 CO ■«*< CO 1 1 


1 1 


1 T-t(o 1 00 CO CM ^ 00 c« 


o» 
a> 


a 

h 




CO O IM O CO'-* 
IM CO lO 


1 eOcOTt* 

(M 


»-ISO00'^COC05O'-lC0C0IMC0 
CO CM 


oo 


•< 
a 
a 

Cm 

s 




1 COt^Or-" 1 


1 CM O <M 

<M 


1 l<M|Tf<|rt| 1 llCCO 


to 

50 


H 
Z 




CO O Cd »H 
IM -rt* 




.-HtojOTftcqco'C'-HCocor^o 


oo 

CO 



•^iClOOOSi— II— I005O'* I 05Tj<00CM<OCMt^t^»-<i0O 
tOOr-t CMOS— <00!M-H CM CO 



eO'*'^COOO»-<C^O'-1U5'-<'^cD05C6COOt^COlOtOO 
CO to iC CO Cd CM Ttl Tt< 



lOCMto I CM r~. »-( eo CO CO — I o CO —< CO "5 < 

I CM IM Tt< CO CM CM CM CM ' 



•eiB^ox 



oeMc^a>»^cocococMkCCM»C't<'»j<oocM^cececo»cr^ 
»-<t>.cocoeM _ 



o 



2 o 



S| §.S 



3 



^gCggScsScS 

a-sl3 « cs o « S-C 



c o 

<U c . 



i?.D. 117. 



161 



■it 



CO 

.o 



Married. 




Ttioo»OrtOi-i(rciTt<05rt,-(i-^Tj<«oooTtioo»occ>-*-*o 

lO "-H lO COOii-l O CO-* OO CO .-1 00 CO 


1,143 


•S9^T3ra9j[ 


|Ttia:05lO 1 (M ""^ ^ O ^ CD 02 C<l kfS 00 03 CO 
CM (M .-( Csl 'tlOSCOCOr-l 


CO 

t>- 

lO 


•saiBj\[ 


•>S<-^t<COC<IlOr-l 1 O com 1 lOlO-^-^t^rtCOOOCDirat^ 
cocoes) 1-1 rtOrtlOrtrt CO 


o 



•S9113I\[ 



■s^ox 



•S]•B:^ox 



I O «0 rH I T-H 



< CO <-l (M I-H 



05 C<l 00 LI <N (M 



■eitJ^ox 



iCMrt05iOi-i»-(coo5csrtCooo»oi-^ooa50ocot 



CO 03 OO CM »o 1 



•eiT3^ox 



oo^c^05»-lcocoocM^f5C^":)•*■^ooo^'-|«^oco^o^^ 
i-it--cococq TtieqT-i o^t>"-ii>'COcoco" 

CSCOCM 



l-H CO CO 



> 00 >0 CO CO CO 
I CM CM I— I CO 0> CO 



as CM CM 03 i-H CO 



_o c3 _Q *: fl fcj 

j3 gj3-C-i3x;'o as-a-d'S'p 



o 

8 

o 0.2 

w C S--- O 

g o '^^ca 

(H 3 « 



^-I cm' ec TjJ lo' CD t>; 00 05 o —I cm' eo 



-.2 - « o ^? ,2 
QJ C S?^ " c3 o -2 



162 



P.D. 117. 



Table 23. — Psychoses of Readmissions at Public Institutions for the Insane and 

McLean Hospital. 



Psychoses. 


Males. 


Females. 


Totals. 


1. Traumatic psychoses ......... 


1 




1 


2. Senile psychoses ......... 


10 


12 


22 


3. Psychoses with cerebral arteriosclerosis ..... 


10 


18 


28 


4. General paralysis ......... 


22 


4 


26 


5. Psj'choses with cerebral syphilis ...... 

6. Psychoses with Huntington's chorea ..... 


3 


2 


5 








7. Psj'choses with brain tumor ....... 








8. Psychoses with other brain or nervous diseases 




2 


2 


9. Alcoholic psj choses ......... 


45 


4 


49 


10. Psj'choses due to drugs and other exogenous toxins 


2 


5 


7 


11. Psychoses with pellagra ........ 




1 


1 


12. Psychoses with other somatic diseases ..... 


6 


5 


11 


13. Manic-depressive psychoses ....... 


89 


143 


232 


14. Involution melancholia ........ 


5 


9 


14 


15. Dementia prcecox ........ 


122 


123 


245 


16. Paranoia and paranoid conditions 


6 


10 


16 


17. Epileptic psychoses ........ 


10 


8 


18 


18. Psychoneuroses and neuroses ....... 


3 


7 


10 J 


19. Psychoses with psychopathic personality .... 


10 


7 


17 1 


20. Psychoses with mental deficiency ...... 


12 


13 


25 


21. Undiagnosed psychoses ........ 


19 


21 


40 


22. Without psychosis 


8 


9 


17 


Total 


383 


403 


786 



P.D. 117. 



163 



I .-I I I I I CO 



•sait;uiaj[ 



■ CO >-H I I »H kfS > 



ICO'^>0 0»OOT»<«Ob»>f5<— I 



( !>. «0 CO (M I .-l«©t~. 



OlC00C000-^Tt<05. 



,^^^Tt<(M<£)'*<COIMCO 
CO'^'»f<O0(M^CO(MTf<t^ 
CO 



lCflt^"5T»<l ICOCO^t-Ht 



CO 0»C1 03 CO I I o ■ 



CO OO 05 »-l 1 CO I I to 



OiOOOOOOSr-iOOCOtOcO 



o 



to Ot C 
•5 >j o 



Has 



o 
|.S 

C c8 



o ia o « g<x: 
ta ;3 o *^ t3 

a » 2 .ti c« 

O P 



OJ in 
O o • 

« •!> 

tc c3 O in 
b£ >-< CO a> 

I-. c5 s a 

S:S:2 S P g rt.^ o 
3 .t^ .-S ce <u is a ^- « -ti c o 



c o c 

o 



i(MC0'^kC«0t^00OO-^<MC0Tt<»0< 



164 



P.D. 117. 



ft 




llllllllCMr-^ll^ll 


IM 1 


1 C<1 


1 1 CS^ 1 1 1 1 1 1 1 


1 CO 1 


glut: 

,ANCH 


•SaiBtU3j[ 


1 1 1 1 1 1 1 1 1 1 1 1 M 1 




1 


1 1 CM 1 1 1 1 1 1 1 1 


1 CM 1 






1 1 1 1 1 1 1 1 (M ^ 1 1 1 1 






1 1 1 <^ 1 1 1 1 1 1 1 


1 F-" 1 






lllllllll— l||-«»<-H 




CM (M 


1 1 CO 1 1 1 CM 1 1 1 


1 


I ANIC 
•RESSl 


•sa[Btuaj[ 


Illllllll^ll05rt 


CO 




1 \ Oi I 1 1 CM 1 1 1 


. 1 


^3 

Q 




1 J 1 1 1 1 1 1 1 1 1 1 >o 1 






1 1 ■<*• 1 1 1 1 1 1 1 


. - 1 


COHOLIC. 




1 1 1 1 1 1 1 1 1 1 1 1 CO 1 






1 1 T-l 1 1 1 ^ ^ 1 1 1 


1 CM 1 






►J 

<; 







US 




, , , 


1 CM 1 


►J oJ 
<; S 




1 1 1 1 1 1 1 1 1 (74 1 1 CO 1 






1 1 CM^ 1 .-■ 1 1 1 1 1 


1 1 1 


ENER. 
HALTS 




1 1 1 1 1 1 1 1 1 tM 1 1 ^ 1 






1 J 1 1 1 1 1 1 1 1 








1 1 1 1 1 1 1 1 1 1 1 1 (M 1 






1 1 CMOO 1 1 1 1 1 1 




^ 6 2 




1 1 1 1 1 1 1 1 1 ^ 1 1 1 


1 1 


1 1 CM 


1 CO OO 1 1 1 1 CO 1 1 1 
CO 


1 OS 1 


M « 2 
£ o « o 

£ « « K 

^ « s « 

H " ►J 




1 1 1 1 1 1 1 1 1 1 1 1 1 1 




1 1 (M 


1 CM OO 1 1 1 1 CO 1 1 1 


1 CO 1 






1 1 1 1 1 1 1 1 1 <-l 1 1 ««< 1 


I 1 




1 -^O 1 1 1 1 1 1 1 1 

CM 


1 CO 1 






1 1 1 1 1 1 1 1 1-1 1 1 1 «o 1 


1 05 




1 CM "5 1 1 >0 1 rH 1 1 1 


1 1 


H 




1 1 1 1 1 1 1 1 ^ 1 1 1 eo 1 


1 >o 




1 1 1 »0 1 ,-1 1 1 1 


1 t>. 1 






1 1 1 1 1 1 1 1 1 1 1 1 CO 1 




1 1 1 


1 — l-*^ 1 1 1 1 1 1 1 1 












1 CO CO 


1 rt00t^«003>0OC0 1 
^ 00 OS CM CO 


CM '* CM 


rOTAI 




1 1 1 1 (N 1 d 1 >*«OCJ 1 CO 

00 




1 CMt- 


1 lO-*t^"*t~'^00>O 1 CO 


t» 1-1 






1 1 1 1 1 ICOI-^lfSlT-OOCO 

to 


1 o 


1 


1 COt»<0«CM.^CM— « 1 
■^m ^ C^ 


CM 



•2 ^ . . . . ^ 

2 a -I § -Sc. g 

2 a jI • • ■ • -li a 

I m 

a .-a 

> 53 ^ 3.2<»o c 2 



"S, ■ 



OQ<JOOWPQOWOO 



o a 

a « a 

a> 5 Qj 



P.D. 117. 165 

























1 >-< 1 <-i 






























1 1 C4 C4 1 




1 1 1 1 


















-111. 






















































s 


1 1 CO iM 1 




1 •-■ 1 1 






1 1 1 1 




1 








C^l 1 <-■ 1 1 


CO 


1 (M 1 
























CO 




























1 ^ lO 1 


CO 


1 a> 1 1 




1 1 (M 














>-< IM 1 1 1 




1 1 1/S ^ 




C4 0(N 1 ( 




















5? 

(M 


























CO 


1 1 >0 ^ i-H 




O t— 1 1 






1(11 














CO 

OO 


1 1 O 3 1 

o o 




5 ^ ' ' 






















' ' ^ Ss ' 




^ ' ' 










1 CO 1 1 












1 1 a> 1 




1 OJ 1 1 




1 1 i 


1 1 1 1 














CO 


























■5 

CM 






^ ^ ^ 






















1 1 o> ^ 1 

CO 




1 "5 1 




1 1 1 


1 1 




1 CO 1 






1 


... I 1 


o 






•OOOOIM 1 




' ' c5 


0< «0 CO CO 




COrjHCOUS 




"5 1 


CO 


c<i »o ■— 1 Ol 






























1 -<J«0-H 1 


























cvi CO -H CO M evi 
ir<s> CO 


so <M 1 




1 1 




■<«' 


CO 00 CM 1-1 


■<1< 


<M 1 




CVl CM ■>}< 


OO 
CO 



2 -B 

S OS O <n 



. .a I 

•II I 

a, « 2 



o o 



.a S « §T3T3 

o<:o<oo 



a:: 

G O 
3 « 



Si 

3 S 
C a, 



a) *^ -rs — ' 



O S O o * 



o 

.2 00. 2.2 



PoQ<;Koooo 



^ Is 

§'«.2°°2 



2 i 



o 

03 
4) 



s a a 



3« „ 

m ii C 0) <-> 

-5 41 a> w , o 

l^^aS ^ 



166 



P.D. 117. 



L Other 

IfCHOSES. 






I CO C>^ 1 1 05 »-< 


1 00 


1 ^ 


1 r-< 0> ^ \ ICO 


1 "5 1 




1 1 1 1 1 1 


, 1 1 


1 rf 


1 1 1 


1 Tt< 1 CO <N 1-1 1 1 CO 


1 1 


>J m 




1 1 1 1 1 1 1 


1 (M »-< 1 1 CO 1 


1 Tf< 


1 —"C^ 


1 1 u5 ^ ^ 1 1 1 1 1 


1 1 


„ ^ 






1 1 1 1 1 






1 1 1 1 1 1 1 1 1 1 




With 
Ment/ 
Deficiei 




1 1 1 1 1 1 1 


1,1,1^1 


. ^ 


1 1 1 


-7T7T77TT77T- 


1 1 1 






1 1 1 1 1 (N i-H 




1 1 1 












w c 

K p ffi S5 
& S W 




1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 






1 1 1 1 1 1 1 1 1 '-H 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 III 


i, a H 
















" « 5 « 
« ^ » 


































1 1 CM 1 1 1 1 1 '<tl 1 1 

eo 


1 »-< 1 


k'CHOS 




1 1 1 1 1 1 1 


1 »^ 1 1 CO 1 














1 1 1 1 1 1 1 


1 1 1 1 CC 1 






1 1 ^ 1 1 1 1 1 O 1 1 
CM 




Paranoia 
OR Paranoid 
Conditions. 














1 1 1 


















1 1 1 


-< • 
E 






CM (M 1-1 05 U5 
05 










^ 




1 1 1 1 i-H 1 


P< — i(M 1 — ( 


to 




1 « 1 CM 1 1 »^ 1 1 








1 1 1 1 1 1 CM 


1 « 1 ^(M.^ 


eo 




1 « 1 1 iCi 1 ^ ^ 1 





a .2 a 

■-3 So 

a K £ § 

QJ Ho 2 



„ « • C !5 fl C 

?Ja -^-ii^ 

!.g< O bC »- t,.-. o 



® 2 "fee a 

£■-2 g cs a 
s§-S-i^a 



QO 



OHUO 



O '.2 
•2:5.2 

" S3 

<B 5 © 



P.D. 117. 



167 



00>O I OS 



1-1 I CO CO I <M 



CO CO I 



9 <U 

>, 

• • • • §3 o 1 

■ aj • Qj o ito 

r o-r) O CO (C 
S O C !R =3 03 

mill 

u<;o<!oo 



ii 

2 i 



I I CO 



■a TO 



o 



2^ S . 

— O -3 

-b.S ^ 

g _g o a> 



t) H 5^ 



s 

03 

o ° is 

lit 



a? So 

^ sn -»-> 



•T3 • 
*^ 0-0--S O 



'-3 



41 



CQpqH-3eL,<t;Oo 



a Si's. is 



b hi 

CD a> ■ 
OO 



^ ° ° ^ 



CO 



s i o 

^ « o 
Sec 



a 



5 a .2 
o 5 . > 



d a> 5 



168 



P.D. 117. 









1 






35-40. 






CO 








r 1 I05I 1 1 icci 1 lcclooltOl-H^s| i 


CO 








1 1 1 ^ 1 1 1 1 1 ^ Iti fN» 1 ^ ^ 1 ^ 1 
« CM 


s 




lA 
CO 




1 1 1 -H— < 1 1 1-4 1 1 1 -HIO-hO I 1 — 1 1 C» 1 1 


CO 
CM 




o 
ro 














1 1 1 00 1 1 1 1 1 1 1 1 1 y-i 1 Iff 1 1 1 1 










1 1 IC55I 1 1 1-^COI001<MI l-HC«»-H 


«*< 




25-30. 




1 1 1 CO 1 1 1 1 1 1 1 (MfO 1 i-l 1 1 1 1 1—1 




Yeahs. 




saiBj^ 


1 1 l«OI 1 1 1^1 l<MI It^lT-ll 1 '-"(M 1 


o 






1 1 1 1 1 1 1 1 1 1 1 CO-^ 1 <M 1 1 1 -H,^ 1 


C» 
CM 




20-25. 




iiiiiiiiiiicoii<ei«ii 1 


CM 






IIIIIIIIIIII^ICOICCIIIII 


o 






•si^^ox 


lll^llllllllll<M|lOII 1 


o 




15-20, 




lll-H|||tllllll«lCOIII^I 








■ sa^B j/^ 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 (M 1 1 ^ 1 1 


CO 






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Traumatic 

Senile 

With cerebral arteriosclerosis .... 

General paralysis 

With cerebral syphilis 

With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases . 

Alcoholic 

Due to drugs and other exogenous toxins . 

With pellagra 

With other somatic diseases .... 
Manic-depressive 

Dementia prsecox 

Paranoia or paranoic conditions .... 

Epileptic psychoses 

Psychoneuroses and neuroses .... 
With constitutional psychopathic inferiority 

With mental deficiency 

Undiagnosed 

Not insane 








Total 






^-<e^eo^»o«o^-•odo50-|J^co^>««o^~odo50 





P.D. 117. 



169 



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170 



P.D. 117. 



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P.D. 117. 



171 



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172 



P.D. 117. 



DIRECTORY OF INSTITUTIONS. 

PUBLIC. 

Worcester State Hospital (opened 1833) : — 

Trustees: Edward F. Fletcher, Worcester, Chairman; Miss CaroUne M. 

Caswell, Boston, clerk; Dr. Wm. J. Delehanty, Worcester; Luther C. 

Greenleaf, Boston; John G. Perman, D.D.S., Worcester; Howard D. 

Cowee, Worcester; Mrs. Anna C. Tatman, Worcester. 
Regular meeting: Second Tuesday of each month. 
Superintendent: William A. Bryan, M.D. 
Assistant Superintendent: Ransom H. Sartwell, M.D. 

Assistant Physicians: Michael J. O'Meara, M.D.; Leon E. Duval, M.D.; 

George A. Gaunt, M.D.; Mervin Fossner, M.D.; Manley B. Root, M.D.; 

John Saucier, M.D.; Henry P. Weyler, M.D.; John P. Powers, M.D.; 

Paul DeCary, M.D. 
Pathologist: Clarence A. WHiitcomb, M.D. 
Dentist: Carl A. Oberg, D.M.D. 
Steward: Herbert W. Smith. 
Treasurer: Jessie M. D. Hamilton. 

Visiting days: Tuesdays, Saturdays, Sundays, 10-11 a.m., 1-4 p.m. 
Staff Meetings : Daily ."^ 

Location: Belmont Street, Worcester, one and a half miles from Union Sta- 
tion (Boston & Albany; New York, New Haven & Hartford; and Boston 
& Maine). 

The Summer Street Department is located in the building formerly known as 
the W^orcester State Asylum, on Summer Street, Worcester, about five 
minutes' walk from the Union Station (Boston & Albany; New York, 
New Haven & Hartford; and Boston & Maine). 

Correspondence relating to patients should be addressed to the Superintendent, 
Worcester State Hospital, Worcester, Mass. 

Correspondence intended for the Steward or Treasurer of the Hospital should 
be addressed to the Worcester State Hospital, Worcester, Mass. 

Taunton State Hospital (opened 1854) : — 

Trustees: Arthur B. Reed, North Abington, chairman; Mrs. Ehzabeth 
C. M. Gifford, Cambridge, secretary; Simeon Borden, Fall River; Charles 
C. Cain, Jr., Taunton; Julius Berkowitz, New Bedford; Mrs. Margaret 
C. Smith, Taunton; Philip E. Brady, Attleboro. 

Regular meeting: Second Thursday of each month. 

Superintendent: Ransom A. Greene, M.D. 

Assistant Superintendent: Roderick B. Dexter, M.D. 

Senior Assistant Physicians: John J. Thompson, M.D.; Fannie C. Haines, 
M.D. 

Assistant Physicians: Samuel Tartakoff, M.D.; Charles A. DeCary, M.D.; 

Clarence M. KeUey, M.D.; Rodolphe M. Richard, M.D. 
Pathologist: Wilfred H. Baines, M.D. 
Dentist: George A. Harris, D.D.S. 
Treasurer: Frank W. Boynton. 
Steward: Stephen F. Tracy. 
Visiting days : Everyday. 
Staff meetings: Daily, 8.15 a.m. 

Location: Hodges Avenue, Taunton, one mile from railroad station (New 
York, New Haven & Hartford). 

Northampton State Hospital (opened 1858) : — 

Trustees: Luke Corcoran, M.D., Springfield, Chairman; Joseph W. Stevens, 
Greenfield, Secretary; Miss Caroline A. Yale, Northampton; Mrs. Emily 
N. Newton, Wellesley; Harry L. Howard, Hatfield; Edward C. Gere, 
Northampton; Charles W. King, Chicopee Falls. 



P.D. 117. 



173 



Regular meeting: first Thursday of each month. 
Superintendent: John A. Houston, M.D. 

Assistant physicians: Edward W. Whitney, M.D.; Angela Bober, M.D.; 

Harriet W. Whitney, M.D.; Elizabeth Thomas, M.D. 
Dentist: Lucien H. Harris, D.D.S. 
Treasurer: Eva L. Graves. 
Steward: Frank W. Smith. 

Visiting days: for relatives and friends Tuesdays, Fridays, and Saturdays, 
on which days members of the medical staff are in attendance to consult 
with visitors; but if impossible to come on those days, visitors may come 
on any day but Sunday, which is visiting day only in emergency cases. 

Location: Prince Street (''Hospital Hill"), Northampton, one and one-half 
miles from the railroad station, reached by taxicab (Massachusetts Central 
and Connecticut River branches of Boston & Maine; and New Haven and 
Holyoke, Northampton branches of the New York, New Haven and Hart- 
ford). 

Danvers State Hospital (opened 1878) : — 

Post office and railroad station, Hathorne (Boston & Maine) . 

Trustees: S. Herbert Wilkins, Salem, chairman; Samuel Cole, Beverly; 

James F. Ingraham, Peabody; Arthur C. Nason, M.D., Newburyport; 

Louise M. Porter, Peabody; William W. Laws, Beverly; Anna P. Marsh, 

Danvers. 

Regular meeting: second Thursday of each month. 
Superintendent: John B. Macdonald, M.D. 
Assistant Superintendent: Edgar Maule Blew, M.D. 

Assistant Physicians: Guy C. Randall, M.D.; Otis F. Kelly, M.D.; H. 

Lincoln Chase, M.D.; Isadore Greene, M.D.; J. Charles Lapierre, M.D.; 

Jean C. Miller, M.D.; Chas. L. Clay, M.D.; Lillian G. Moulton, M.D. 
Resident Dentist: Mesrop N. Moo;:adkanian. 
Treasurer: Miss Gladys Leach. 
Steward: Adam D. Smith. 
Visiting days : every day. 
Staff meeting : daily, 8.00 a.m. 

Location: Maple and Newbury Sts., Danvers, one-quarter mile from rail- 
road station. 



Westborough State Hospital (opened 1886) : — 

Trustees: N. Emmons Paine, M.D., West Newton, Chairman; Miss Flora 
L. Mason, Taunton, secretary; Mr. Sewall C. Brackett, Boston; Mr. 
Thomas F. Dolan, Newton; Mr. Stanley F. McGarry, Grafton; Charles 
L. Nichols, M.D., Worcester; Mrs. Emily Young O'Brien, Brookline. 

Regular meeting: second Thursday of each month. 

Superintendent: Walter E. Lang, M.D. 

Assistant superintendent: Vacancy. 

Senior Assistant Physician: Frank J. Gale, M.D. 

Assistant Physicians: Emma H. Fay, M.D.; Belle J. Allen, M.D.; William 

C. Gaebler, M.D.; Edgar C. Yerbury, M.D. 
Pathologist: Lydia B. Pierce, M.D. 
Dentist: Anthonv B. Grady, D.D.S. 
Steward: P. I. Wiley. 
Treasurer: Carrie P. G. Nelson. 
Visiting days : Every day. 
Staff meetings: daily. 

Location: Two and one-quarter miles from Westborough Station (Boston & 
Albany); one mile from Talbot station, (New York, New Haven & Hart- 
ford R.R.). 



174 



P.D. 117. 



Boston State Hospital (opened 1839) : — 

Trustees: Henry Lefavour, Boston, chairman; Mrs. Katherine G. Devine, 
South Boston, secretary; John A. Kiggen, Boston; WiUiam F. Whitte- 
more, Boston; Charles B. Frothingham, M.D., Lynn; Mrs. Edna W. 
Dreyfus, BrookUne; David M. Watchmaker, Boston. 

Regular meeting: third Monday of each month. 

Superintendent: James V. May, M.D. 

Assistant Superintendent: Ermy C. Noble, M.D. 

Senior assistant physicians: Mary E. Gill-Noble, M.D.; Edmund M. Pease, 
M.D.; Geneva Tryon, M.D.; John C. Lindsay, M.D.; Herbert E. Herrin, 
M.D.; Roy D. Halloran, M.D. 

Assistant physicians: Anna E. Steffen, M.D.: Alberta S. B. Guibord, M.D. 
(School Clinic); Franklin L Flagg, M.D.; Jacob Kasanin, M.D. 

Dentist: Lawrence H. Stone, D.M.D. 

Steward: Arthur E. Gilman. 

Treasurer: Adeline J. Leary. 

Visiting days: 2 to 4 p.m., daily. 

Staff meetings are held four times a week. 

Location: East Group, Harvard Street, Dorchester, near Blue Hill Avenue; 
West Group, Walk Hill Street, Dorchester; about one-half mile from rail- 
road station; post office, Dorchester Center, 24. 

Boston Psychopathic Hospital (opened 1912): 

Trustees: William Healy, M.D., Boston, Chairman; Channing Frothing- 
ham, Jr., M.D., Boston; Allen W. Rowe, Ph.D., Boston; Mrs. Esther M. 
Andrews, Brookline; Mr. Charles F. Rowley, Boston; Hon. Wm. J. 
Sullivan, South Boston; Mrs. Helen B. Hopkins, Boston. 

Trustees' Meeting: second Friday of each month. 

Director: C. Macfie Campbell, M.D. 

Chief Executive Officer: W. Franklin Wood, M.D. 

Chief Medical Officer: Karl M. Bowman, M.D. 

Executive Officer: Arthur E. Pattrell, M.D. 

Medical Officer: Alfred H. Ehrenclou, M.D. 

Assistant Medical Officers: Ehzabeth I. Adamson, M.D.; Wm. Herman, 

M.D.; Arthur W. Young, M.D. 
Medical Internes: Geo. E. Daniels, M.D.; Henry H. Hart, M.D. 
Chief of Out-patient Department: Martin W. Peck, M.D. 
Out-patient Medical Officer: Olive A. Cooper, M.D. 
Out-patient Medical Officer: Charles B. Sullivan, M.D. 
Chief of Psychological Laboratory: F. Lyman Wells, Ph.D. 
Chief of Therapeutic Research: Harry C. Solomon, M.D. 
Chief of Biochemical Laboratory: G. Phihp Grabfield, M.D. 
Assistant Pathologist : Mary Elizabeth Morse, M.D. 
Roentgenologist: Whitman K. Coffin, M.D. 
Chief of Social Service: Suzie L. Lyons. 
Head Occupational Therapist : Ethel wyn F. Humphrey. 
Superintendent of Nurses: Mary Fitzgerald. 
Treasurer: Anne B. Kimball. 
Staff meetings: every day, except Saturday. 
Visiting days: every day, 2 to 4 p.m. 

Location : 74 Fen wood Road, near corner of Brookline Avenue. 

Grafton State Hospital, formerly Worcester State Asylum (opened 1877) : 

Trustees: Winslow P. Burhoe, Boston; Margaret A. Cashman, Newbury- 
port. Secretary; Ernest L. Anderson, Worcester; Frank B. Hall, Worcester, 
Chairman; Francis Prescott, Grafton; Flora M. Cangiano, Hingham; 
Enos H. Bigelow, M.D., Frainingham. 



P.D. 117. 



175 



Superintendent: Harlan L. Paine, M.D. 
Assistant Superintendent: H. L. Horsman, M.D. 

Assistant Physicians: Mary Johnson, M.D.; H. Wilbur Smith, M.D.; Buell 
L. Ashmore, M.D.; James L. McAuslan, M.D.; T. Roland Ekwall, M.D.; 
Chas. E. LaFleur, M.D. 

Treasurer: Susie G. Warren. 

Steward: John McRae. 

Visiting surgeon: Lemuel F. Woodward, M.D. 
Dentist: George 0. Tessier, D.M.D. 

Visiting days, for relatives or friends, every day; for the general public, 
every day except Sunday. 

Location : The hospital is situated on the main line of the Boston and Albany 
Railroad, between Worcester and Westborough, about eight miles from 
Worcester, and can be reached by trolley from Worcester or from the 
Westborough or North Grafton stations of the Boston & Albany Railroad, 
or from the Lyman Street crossing of the Boston & Worcester electric 
cars. Correspondence relating to patients at the Grafton Hospital should 
be addressed to the Superintendent, Grafton State Hospital, North Grafton, 
Mass. 



Medfield State Hospital (opened 1896) : — 

Post Office, Harding: railroad station, Medfield Junction (New York, New 

Haven & Hartford Railroad). 
Trustees: Walter Rapp, Brockton, chairman; Christian Lantz, Salem, 

secretary; Mrs. Carolyn B. Odell, Belmont; Eugene M. Carmen, Somer- 

ville; George 0. Clark, M.D., Boston; Danforth W. Comins, Winchester; 

Mrs. Bessie Edwards, Westwood. 
Regular meeting: second Thursday of each month. 
Superintendent: Ehsha H. Cohoon, M.D. 
Assistant Superintendent: Winfred Overholser, M.D. 

Assistant Physicians: George A. Troxell, M.D.; George E. Poor, M.D.; M. 

Alvord Gore, M.D.; Wm. T. Cluney, M.D.; Alexandria Ameer, M.D.; 

Arthur Berkowitz, M.D. 
Dentist: Elton V. Faas, D.M.D. 
Treasurer: Miss Josephine M. Baker. 
Steward : Louis A. Hall. 

Staff meetings : Every morning, except Sunday. 

Location: Asylum Road, one mile from Medfield Junction railroad station. 

Gakdner State Colony (opened 1902) : — 

Post office, Gardner; railroad station. East Gardner. 

Trustees: Frederick A. Washburn, M.D., Chairman; Mrs. Amie H. Coes, 
Worcester, secretary; Owen A. Hoban, Gardner; George N. Harwood, 
Barre; Mrs. Alice Miller Spring, Fitchburg; Thomas H. Shea, Fitchburg; 
Thomas R. P. Gibb, Belmont. 

Regular meeting: first Friday occurring on or after the fourth day of each 
month. 

Superintendent: Charles E. Thompson, M.D. 
Assistant Superintendent: Arthur N. Ball, M.D. 
Senior Assistant physician: Lonnie O. Farrar, M.D. 
Assistant physician: Harry A. Schneider, M.D. 
Dentist: Herman E. Danofsky, D.D.S. 
Treasurer: Gertrude W. Perry. 

Visiting days: every day at any hour, including Sundays and holidays. 
Staff meetings: daily, 8-9 a.m. 

Location: - East Gardner, two minutes' walk from East Gardner railroad 
station. 



176 



P.D. 117. 



FoxBOROUGH State Hospital (opened 1893). Devoted exclusively to the care 

of the insane since June 1, 1914) : — 
Trustees: Claire H. Gurney, Wollaston, Chairman; Minna R. Mulhgan, 

Natick, secretary; Thomas J. Scanlan, M.D., Boston; Isaac Heller, Boston; 

Maxime Lepine, Lowell; William H. Bannon, Foxborough; Charles A. 

Littlefield, Lynn. 
Regular meeting: second Tuesday of each month. 
Superintendent and Treasurer: Albert C. Thomas, M.D. 
Senior assistant physicians: Ransom H. Sartwell, M.D.; Cornelia B. J. 

Schorer, M.D.; Wilmarth Y. Seymour, M.D. 
Assistant physician: William Malamud, M.D. (pathology). 
Visiting days: every day from 9 to 11 a.m. and 2 to 5 p.m. 
Staff meetings: daily, except Sundays and hoHdays, at 8.30 a.m. 
Location : one mile north of Foxborough Center. 

MoNsoN State Hospital (opened 1898) : — 

Post office and railroad station, Palmer (Boston & Albany). 

Trustees: George A. Moore, M.D., Palmer, Chairman; Mrs. Mary B. 

Townsley, Springfield; William Jameson, Chicopee Falls; George D. 

Storrs, Ware; J. Ubalde Paquin, M.D., New Bedford; Mrs. Elizabeth 

Hormel, Roxbury; Henry K. Hyde, Ware, Secretary. 
Regular meeting: first Thursday of each month. 
Superintendent: Morgan B. Hodskins, M.D. 
Assistant Superintendent: Earl K. Holt, M.D. 

Senior Assistant Physicians: Donald J. MacLean, M.D.; Samuel 0. Miller, 
M.D. 

Assistant Physician: Chas. Kirkland, M.D. 
Assistant Physician: Lucie G. Forrer, M.D. 
Treasurer: Sarah E. Spalding. 
Steward: Charles F. Simonds. 
Visiting days : Every day. 

Staff meetings: Every day, except Sundays and holidays, at 8.30 a.m. 
Location : one mile from railroad station. 

Massachusetts School for the Feeble-minded at Waltham (opened 1848) : — 

Post office and railroad station, Waverley (Boston & Maine). 

Trustees appointed by the Governor: Francis J. Barnes, M.D., Cambridge; 
Prof. Thomas N. Carver, Cambridge; Frederick H. Nash, Auburndale, 
Treasurer; Frank H. Stewart, Newton; Mrs. Helen C. Taylor, Newton. 

Trustees appointed by the Corporation: Frank G. Wheatley, M.D., North 
Abington, President; Charles Francis Adams, Concord, Vice-president; 
Charles E. Ware, Fitchburg, secretary; Roger S. Warner, Boston; Francis 
H. Dewey, Worcester; Paul R. Withington, M.D., Milton. 

Quarterly meeting: second Thursday of October, January, April and July. 

Superintendent: Walter E. Fernald, M.D. 

Assistant Superintendent: C. Stanley Raymond, M.D. 

Assistant Phvsicians: Anna M. Wallace, M.D., Edith E. Woodill, M.D.: 
L. Maude Warren, M.D.; Mary T. Muldoon, M.D.; Esther S. B. Wood- 
ward, M.D. 

Treasurer: Emily E. Guild. 

Steward : John F. Donnell. 

Visiting days, for the parents or friends of the patients — Wednesday, 
Thursday and Saturday afternoons, and the first Sunday of each month; 
for the general public, every day, except Sunday. 

Staff meetings, daily, at 9 a.m. 

Location: about one mile from Waverley station (Fitchburg Division, and 
Southern Division, Boston & Maine), or Boston Elevated from Harvard 
Square. 



>.D. 117. 



177 



jVrentham State School (opened 1907) : — 
Post office and railroad station, Wrentham. 

Trustees, Albert L. Harwood, Newton, Chairman; EUerton James, Nahant, 
Secretary; Patrick J. Lynch, Beverly; George W. Gay, M.D., Newton; 
Mrs. Mary Stewart Scott, Brookline; Herbert C. Parsons, Newton. 

Regular meeting: first Thursday after the first Monday of each month. 

Superintendent: George L. Wallace, M.D. 

Senior Assistant Physicians: Mildred A. Libby, M.D.; Alice M. Patterson, 

M.D.; Neil A. Dayton, M.D. 
Assistant Physicians: Genevieve Gustin, M.D.; Raymond A. Kinmouth, 

M.D. 

Dentist: John A. Nash, D.M.D. 
Treasurer: Sara M. Clayland. 
Visiting days, every day. 

Location: Emerald Street, Wrentham, one mile from railroad station (New 

York, New Haven & Hartford railroad). 
Staff meetings : everyday. 

Belchertown State School (for feeble-minded; opened 1922): — 

Post office and railroad station — Belchertown, Mass. (Boston & Maine, 
and Central Vt. R.R.) 

Trustees: Dr. Theodore S. Bacon, Springfield; Mr. John R. Callahan, 
Holyoke; Miss Frances E. Cheney, Springfield; Mrs. Henry F. Nash, 
Greenfield; Mr. Henry E. Dean, Worcester; Mr. F. A. Farrar, Northamp- 
ton; Mr. J. A. Skinner, Holyoke. 

Regular meeting: First Thursday of each month. 

Superintendent: Geo. E. McPherson, M.D. 

Senior Assistant Physician: Harvey M. Watkins, M.D. 

Treasurer: Dr. McPherson. 

Visiting days: Every day, 9 to 11 a.m., 1.30 to 4.30 p.m., and at other times 

by special permission. 
Staff meetings: Daily, at 9 a.m. 

Location: One-quarter mile from railroad station, on the state road to 
Holyoke, and one-half mile from the centre of the town. 

Mental Wards, State Infirmary (opened 1866) : — 

Post office, Tewksbury; railroad station, Baldwin (Western Division, Boston 
& Maine), Tewksbury Junction and Salem Junction (Southern Division, 
Boston & Maine). 

Trustees: Galen L. Stone, Brookhne, Chairman; Mrs. Nellie E. Talbot, 
Brookline, secretary; G. Forrest Martin, Lowell; Francis W. Anthony, 
M.D., Haverhill; Dennis D. Sullivan, Middleborough ; Mrs. Mary E. 
Cogan, Stoneham; Walter F. Dearborn, M.D., Cambridge. 

Regular meeting: usually first Tuesday of month. 

Superintendent: John H. Nichols, M.D. 

Assistant Superintendent and physician: George A. Peirce, M.D. 

Assistant Physicians: Sherman Perry, M.D.; WilUam T. Hanson, M.D.; 
Anna E. Barker, M.D.; George M. Sullivan, M.D.; Charles J. Garden, 
M.D.; Amanda Bray, M.D.; Moses J. Stone, M.D.; Charles L. Trickey, 
M.D.; James F. Lawler, M.D. 

Dentist: Sidney P. Stone, M.D. 

Visiting days: every day from 10 a.m. to 4 p.m. 

Staff meetings, daily, at 8 a.m. 

Location: about one-half mile from railroad and from electric cars. Auto- 
mobile from Infirmary meets most of the trains. 

Bridgewater State Hospital (opened 1886, 1895) : — 

Post office. State Farm; railroad station, Titicut (New York, New Haven 
and Hartford). 



178 



P.D. 117. 



Supervision of Department of Correction, Sanford Bates, Commissioner. 
Medical Director: Frank H. Carlisle, M.D. 

Assistant Physicians: Daniel H. Arthur, M.D.; Ernest B. Adelman, M.D.; 

Solomon L. Skvirskj^, M.D. 
Visiting days: for relatives or friends of patients, every day; for the general 

public, every day, with the exception of Sundays and holidays. 
Staff meetings: daih% at 10 a.m. 
Location: one-quarter mile from railroad station. 

The Hospital Cottages for Children, Baldwinsville (incorporated and opened 
1882): — 

President, Herbert S. Morley, BaldwinsviUe; Clerk, Robert N. Wallis, Fitch- 
burg. 

Trustees appointed by the Governor: H. S. Morley, Baldwinsville; George 
B. Dewson, Milton; Arthur H. Lowe, Fitchburg; J. K. Dexter, Spring- 
field; Miss Edith H. Sears, Boston. 

Trustees appointed by the Corporation: Gilman Waite, Baldwinsville, Mrs. 
Edward L. Greene, Fitchburg; Robert N. Wallis, Fitchburg; Frederick P. 
Stone, Otter River; Frederic A. Turner, Jr., Boston; Mrs. Arthur R. 
Smith, Leicester; G. W. Mackintire, Worcester; Dr. H. W. Page, 
Worcester; Dr. John G. Henry, Winchendon; Mrs. J. M. Lasell, AVhitins- 
ville; Mrs. Philip Weston, Pittsfield; Mrs. Paul M. Hubbard, Boston; 
George L. Clark, Worcester; Mrs. Edward W. Hut chins, Boston; Wilham 
Woodward, Worcester. 

Quarterly meeting, third Wednesday of January, April, July and October. 

Superintendent and physician: Harold C. Arey, M.D. 

Psychologist and assistant physician, Caroline A. Osborne, M.D. 

Treasurer, U. Waldo Cutler. 

Visiting days, every day except Sundays. 

Location : Hospital Street, one mile from railroad station (Ware River branch , 
Boston & Albany; and Boston and Maine). 

PRIVATE. 

For Insane, Epileptics and Persons addicted to the Intemperate Use of 
Narcotics or Stimulants. 

McLean Hospital — for Nervous and Mental patients (opened 1818) : — 
Department of Massachusetts General Hospital Corporation. 
Post office and railroad station, Waverley (Boston & Maine R.R.). 
President: Henry P. Walcott, M.D., Cambridge. 
Vice-president: David P. Kimball, Boston. 
Treasurer: Charles H. W. Foster, Needham. 
Secretary: Francis C. Gray, Esq., Boston. 

Trustees appointed by the Governor: Joseph H. O'Neil, Boston; Mrs. 
Nathaniel Thayer, Boston; Thomas B. Gannett, Boston; Galen Stone, 
Boston. 

Trustees appointed by the Corporation: George Wiggles worth, Esq., Boston, 
Chairman; Charles H. W. Foster, Needham; Nathaniel T. Kidder, Boston ; 
William Endicott, Boston; John R. Macomber, Boston; Robert Homans, 
Esq., Boston; Algernon Coolidge, M.D.; Sewall H. Fessenden, Boston. 

Regular meeting: usually at the office of the Treasurer, 50 State St., Boston, 
on Fridays at intervals of two weeks, beginning sixteen days after the first 
Wednesday in February. 

Superintendent: Frederic H. Packard, M.D. 

First Assistant Physician: Theodore A. Hoch, M.D. 

Seajnd Assistant Physician: Freeman A. Tower, M.D. 

Assistant Physician: Sidney M. Bunker, M.D. 

Assistant in Pathological Psychology: Helge Lundholm, Ph.D. 



P.D. 117. 



179 



Chemist, Otto Folin, M.D. 

Assistant in Pathological Chemistry: John C. Whitehorn, M.D. 
Physiologist: Walter B. Cannon, M.D. 
Assistant in Physiology: Clarence J. Campbell, M.D. 
Junior Assistant Physician: Kenneth J. Tillotson, M.D. 
Junior Assistant Physician: — • — 

Staff meetings, regularly, Tuesdays and Thursdays, at 8.30 a.m.; irregularly 

on other days, at the same hour. 
Location: Pleasant Street, one-third mile from railroad station. 

BouRXEWOOD, George H. Torney, M.D., 300 South Street, Brookline. Railroad 

station, Bellevue (Dedham Division, New York, New Haven & Hartford). 

Fifteen minutes' walk. Carriage by previous arrangement. 
Channing Sanitarium, Donald Gregg, M.D., Wellesley Avenue, Wellesley. 
Herbert Hall Hospital, Walter C. Haviland, M.D., 223 Salisbury Street, 

Worcester. Salisbury Street electric car from City Hall Square. 
WiswALL Sanitarium, Harry 0. Spalding, M.D., 203 Grove Street, Wellesley. 

Also at Cartwright Road, Needham. 
Sherwood, J. F. Edgerly, M.D., Lincoln. About two miles from railroad station. 
Highland Hall, Samuel L. Eaton, M.D., 340 Lake Avenue, Newton Highlands. 
Dr. Reeves' Nervine, Harriet E. Reeves, M.D., 283 Vinton Street, Melrose 

Highlands. 

Ring Sanatorium and Hospital, Inc., Arthur H. Ring, M.D., Arlington Heights. 

Carriage. Also at Billerica. 
Private Hospital for Mental Diseases, Edward Melius, M.D., 419 Waverley 

Avenue, Newton. Carriage. Or Commonwealth Avenue car to Grant 

Avenue. 

Glenside, Mabel D. Ordway, M.D., 6 Parley Vale, Jamaica Plain. 
Knollwood, Earle E. Bessey, M.D., 1690 Beacon Street, corner Beacon Street 

and Waban Avenue, Waban (Boston & Albany). 
Bellevue Sanitarium, Mary W. L. Johnson, M.D., 158 Walcott Road, Brook- 
line. 

Westwood Lodge, Wm. J. Hammond, M.D., Westwood. 

For Persons addicted to the Intemperate Use of Narcotics or Stimulants. 

Private Hospital, Frederick L. Taylor, M.D., 45 Center Street, Roxbury. 
Washingtonian Home, Hugh Barr Gray, M.D., 41 Waltham Street, Boston. 
Smith Hospital, Marshall E. Smith, M.D., 47 Merwin Street, Springfield. 

For Feeble-minded. 

Elm Hill Private School and Home for the Feeble-minded, George A. 

Bro\\Ti, M.D., Barre (Central Massachusetts Branch, Boston & Maine). 
Standish Manor, Miss Alice M. Myers, Halifax. 

HiLLBRow School, Franklin H. Perkins, M.D., 16 Summit Street, Newton. 
Highland School, Miss NelHe A. Hunt, East Main Street, Northborough. 
Freer School, Miss Cora E. Morse, 31 Park Circle, Arlington Heights. 

For Epileptics. 

WooDLAW^ Sanitarium, Dora W. Faxon, M.D., 500 Crafts Street, West Newton.